bluuebunny/crossref_metadata_2025 huggingface dataset:
Gynecologic cancer outcomes of Medicare's elderly poor: A population-based study of North Carolina.
Authors: Doll Kemi Morenikeji , Meng Ke , Basch Ethan M , Gehrig Paola A. , Brewster Wendy R. , Meyer Anne-Marie
Published: February 2017

290

Background: Women ≥ 65 years dually enrolled in Medicare and Medicaid (‘Duals’) represent an at-risk group in cancer care, yet their outcomes across the spectrum of gynecologic cancers have not been studied. Our goal was to compare the association of insurance type to stage at diagnosis and mortality of older women after a gynecologic cancer diagnosis. Methods: Population-based, retrospective cohort study of women ≥ 65 years, diagnosed with gynecologic cancers from 2003 – 2009 in North Carolina Central Cancer Registry files. Medicare, Medicaid, and claims from privately insured health plans were linked with census data. Multiple logistic regression, Cox proportional hazard models, and Kaplan Meier survival curves were constructed comparing Medicare, Medicare HMO, and Medicare/Medicaid populations. Results: Among 4,554 patients in the cohort, 3,403 (74%) Medicare+/- supplemental private, 531(11%) Medicare HMO, and 620 (14%) Medicare + Medicaid (Dual). There were 2,215(49%) cases of early stage disease and 1,447(32%) deaths. Dual enrollees had increased mortality rates vs. Medicare overall (HR 1.61, 95%CI:1.4–1.8), and within each cancer site: uterine HR 1.50 (95%CI:1.2-1.9); ovarian HR 1.46 (95%CI:1.1-1.9); cervical HR 1.54 (95%CI:1.0–2.3); and vulvar/vaginal HR 2.84 (95%CI:1.9–4.2). Duals also had increased odds of advanced stage diagnosis in uterine cancer (OR 1.48, 95%CI:1.1–2.0). Stratified survival curves demonstrate the largest disparities amongst women with early stage uterine, advanced stage ovarian, and early stage vulvar/vaginal cancers. Conclusions: Dually enrolled gynecologic cancer patients have a 60% increased mortality rate compared to non-duals despite equivalent stage distribution at the time of diagnosis. Specific site/stage subgroups drive these results and should be the focus of future studies elucidating mediators of these disparate outcomes, including barriers in access to specialty surgical care.
Comparison of Hispanic and non-Hispanic patients with HCC.
Authors: Babalola Atinuke , Miksad Rebecca A. , Oladunjoye Olubunmi , Nwosu Ugonna , Castro-Webb Nelsy , Srivastava Neeharika , Burns Bethany
Published: February 2017

294

Background: In the U.S., Hispanics have a higher incidence of hepatocellular cancer (HCC) and higher disease-specific mortality. The country of origin for Hispanics varies throughout the U.S. However, little is known about Hispanics with HCC in the Northeast. We compared Hispanic and non-Hispanic patients with HCC at a Boston teaching hospital. Methods: Hispanic patients with HCC seen at Beth Israel Deaconess Medical Center (BIDMC) from 1998-2012 were identified in our database. Ethnicity was determined from demographic and language preference information in electronic medical records and supplemented by comparing surnames with the 1990 Census Spanish Surname List. The comparison group was identified by randomly choosing non-Hispanic patients diagnosed the same years as Hispanic patients. We compared both groups using Chi Squared test. Results: 59 Hispanic and 89 non-Hispanic patients with HCC were included in the analysis. The majority (48%) of Hispanic HCC patients were Puerto Rican. Although the median age at diagnosis was similar (59.1 vs 60.3 years for Hispanics and non-Hispanics), there were more women in the Hispanic cohort (28.8% vs 12.4% p0.012). Hispanics had greater odds of not having private insurance (OR 4.24, 95%CI: 2.101, 8.554). Evaluation of HCC risk factors revealed Hispanics were significantly more likely to have hepatitis C (OR 3.68, 95% CI: 1.830, 7.420). In addition, the incidence of Metabolic Syndrome was significantly higher for Hispanics (44.7% vs. 21.7% p0.025). Although individual components of metabolic syndrome were higher in Hispanics, they were not statistically significant: hypertension (52.5% vs 40.4%), Diabetes Mellitus (39% vs 25%), BMI ≥ 30 (39% vs 27%), hypertrigylceridemia (57% vs 52%) and low HDL levels (50% vs 41%). Hispanics were more likely to have received Transarterial Chemoembolization (TACE) and Radiofrequency ablation (RFA) treatments (OR 2.48, 95% CI: 1.261, 4.858). Conclusions: Hispanic HCC patients at BIDMC were more likely to have hepatitis C, metabolic syndrome and to be female than their non-Hispanic counterparts. Outreach to Hispanic communities to identify patients with hepatitis C and metabolic syndrome, particularly in women, may improve HCC prevention, screening and treatment outcomes.
Emergency department use and expenditures among cancer survivors in the United States, 2008-2011.
Authors: Lash Rebecca Salisbury , Bell Janice , Whitney Robin L. , Reed Sarah , Davis Andra , Joseph Jill G.
Published: February 2017

3

Background: The number of cancer survivors in the US surpassed 13 million in 2012. In response to rising costs or care and greater demand for services, recent national reports and policies promote cancer care coordination to reduce costly and potentially avoidable services such as Emergency Department (ED) visits. Such efforts must be informed by reliable estimates and improved understanding of ED use and costs among oncology patients. This study quantifies the extent to which cancer survivors use the ED compared to individuals with other chronic conditions and estimates related annual expenses. Methods: Data from the 2008-2011 Medical Expenditure Panel Survey (MEPS) and survey-weighted regression models were used to determine the odds of any ED use (logistic), counts of ED visits (negative binomial) and mean annual medical expenditures attributed to ED use (generalized linear models) in three groups of respondents: cancer survivors, those with chronic conditions other than cancer, and those with neither (reference group). All models were adjusted for important confounding variables (age, sex, race/ethnicity, education, health insurance and health status). Estimates are generalizable to US non-institutionalized populations. Results: Among individuals with cancer, other chronic conditions, and neither condition, 17%, 15% and 9% visited the ED, respectively. Mean annual expenditures attributed to ED use among those with visits were $1471 (95% CI: $1262-$1678), $1517 (95% CI:$1395-$1640) and $1106 (95% CI: $984-$1228). Cancer survivors and individuals with other chronic conditions consistently had significantly higher ED use and costs than did the reference group. The likelihood of having any ED visit was similar between cancer survivors and those with other conditions, however cancer survivors incurred more visits (IRR: 1.17; 95% CI: 1.01, 1.36). Conclusions: ED use and expenditures are substantial among cancer survivors and equal or exceed the same outcomes in individuals with other chronic conditions. Future research is recommended to explore specific areas of unmet health need that may be driving increased frequency of ED visits in the growing population of cancer survivors.
Transfusion utilization at the end of life.
Authors: Prescott Lauren S. , Brown Alaina J. , Sun Charlotte C. , Levenback Charles F. , Ramondetta Lois M. , Bodurka Diane C.
Published: February 2017

303

Background: Both the AMA’s Consortium for Performance Improvement and the Joint Commission have identified blood transfusions as one of the top 5 treatments that are over-utilized. We sought to quantify packed red blood cell transfusion (PRBT) utilization among ovarian cancer (OCa) pts in the last 6 months of life and identify risk factors for PRBT. Methods: We performed a retrospective cohort study of deceased OCa pts treated at our institution in their last 6 months of life from 2007-2011. Pts who underwent emergent procedures for bleeding were excluded. Demographic and end of life-interventions were compared between transfusion and non-transfusion groups using chi-squared and univariate analysis. End-of-life interventions included anti-cancer treatment (chemotherapy radiation, or hormonal therapy), invasive procedure or abdominal surgery, as well as aggressive end-of-life care as defined by the NQF. Results: Of the 182 pts who met inclusion criteria, 59.9% received a PRBT in the last 6 months of life. Of those pts, 54.1% received a PRBT in the last 30 days of life. Mean hgb level at which pts were transfused was 8.4 ± 0.9 g/dL. Pts received a combined total of 436 units of PRBC. The majority of pts received 1 transfusion (n=50, range 1-16). Mean number of total units transfused was 4 (range 1-25). The most common indication for PRBT was hgb < 9 g/dL (61.1%), followed by symptomatic anemia (21.9%). There was no difference in PRBT rate between pts who received medical interventions in the last 6 months of life v. those who did not. Specifically, transfusion rate was not correlated with: anti-cancer treatments (93.2% v. 92.7%, OR 0.93; 95% CI (0.29, 2.96)), invasive procedures (82.2% v. 81.7%, OR 0.96; CI (0.45,2.08)), abdominal surgery (11.0% v. 11.0%, OR 1.01; 95% CI(0.39,2.59)), or aggressive end-of-life care (46.6% v. 56.9%, OR 1.51; 95% CI (0.83,2.74)). Conclusions: The majority of our pts received a PRBT in the last 6 months of life. We did not identify significant differences in clinical interventions between pts who received a PRBT and those who did not. Based on our analysis, transfusion practices in terminally ill OCa pts should be reevaluated. Creation of transfusion guidelines for cancer pts could potentially result in better utilization of blood bank resources.
Relationship between financial toxicity and health-related quality of life in patients with advanced solid tumors.
Authors: De Souza Jonas A. , Yap Bonnie J.
Published: February 2017

31

Background: Financial toxicity is an important Patient-Reported Outcome (PRO). Its relationship with health-related quality of life (HRQOL) has not been previously described. Therefore, we report the relationship between financial toxicity and health-related quality of life (HRQOL) in patients with advanced cancers. Methods: The global HRQOL was measured by the Functional Assessment of Cancer Therapy-General (FACT-G) and its subscales Physical Well-Being (PWB), Social/Family Well-Being (SWB), Emotional Well-Being (EWB) and Functional Well-Being (FWB). Financial toxicity was assessed by the COST (COmprehensive Score for financial Toxicity), a PRO measure previously developed in 155 patients with advanced cancers. Correlations were calculated using Spearman's correlation. Subject data on tumor type, age, gender, race, income, insurance type and educational level were collected. Results: Fifty patients were assessed. All participants were diagnosed with advanced cancers, were receiving treatment at the time of participation, and had received treatment for at least 3 months. The median COST was 22 (range 0-44), and mean 22.51 (s.d. ±10.80). A negative correlation existed between the COST and HRQOL as measured by the FACT-G (r = -0.47, P <.001), and its subscales: PWB (r=-0.35, p < 0.05), SWB (r=-0.33, p < 0.05), EWB (r=-0.32, p < 0.05) and FWB (r=-0.41, p < 0.01). In this small sample, there were no correlations between the COST and sociodemographic characteristics. Conclusions: Results demonstrate an inverse relationship between patient-reported HRQOL and financial toxicity, suggesting that higher financial toxicity is associated with worse HRQOL. A larger study is in progress to identify cancer patients at higher risk of financial toxicity.
Overuse of five expensive oncology pharmaceuticals in the southeastern United States: A physician-level analysis.
Authors: Bennett Charles L. , Huff Dinah Faith Q. , Shimp William S. , Baranwal Anmol , Mamgain Avinash , Fishman Marc L. , Davis Sharon , Kogler Jurgen , Schorer Anna E. , Bobolts Laura Rose , Armitage Melissa , Hrushesky William J.
Published: February 2017

33

Background: The Wall Street Journal recently identified that the highest rates of use of erythropoietin to Medicare-covered persons with cancer in the United States was by 11 oncologists who practiced in Florida (WSJ, June 20, 2014). We asked a related, but similar question: Could chemotherapy claims databases be used to identify individual physicians in the southeastern United States who had high rates of prescribing five expensive oncology agents: levoleucovorin (Fusilev), palonosetron plus fosapretitant (Aloxi+Emend), peg-filgastrim (Neulasta), albumin-paclitaxel (Abraxane), and epoetin/darbepoetin? Methods: Chemotherapy requests for more than 2,000 oncologists who practiced in the southeastern United States for the years 2012- 2014 were reviewed. A “high user” oncology provider for a specific drug was operationally defined as an individual whose number of prescriptions for the specific drug was more than 2 standard deviations above that for other oncology providers whose chemotherapy requests were also contained in the same database. Results: Two out of 1,479 oncology providers were identified as “extremely high users” of expensive oncology drugs (operationally defined as a high user for 5 of the 5 study drugs), two were “very high users” of expensive oncology drugs (a high user for 4 of the 5 study drugs), and 25 were “high users” (a high user for three of the five study drugs). The overwhelming majority of oncology providers (1,450) were neither extremely high, very high, nor even high users of the five study drugs. Conclusions: In the Southeastern United States, a small number of oncology physicians are extremely high, very high, and high users of expensive oncology drugs. Additional studies are needed to evaluate case-mix and other patient-related factors that might explain this finding. Focused quality improvement initiatives might also be considered. [Table: see text]
Characteristics of emergency department visits among non-admitted oncology patients.
Authors: Fraile Belen , Schleicher Stephen , Baugh Christopher , Bunnell Craig A. , Mersereau Robert , Potiris Spyros , Jacobson Joseph O.
Published: February 2017

37

Background: Use of costly emergency department (ED) resources is high amongst oncology patients. However, many oncology patients who visit the ED are discharged home without admission to an inpatient setting. A better understanding of why this group of patients presents to the ED can inform alternative interventions to shift care to less costly settings and reduce ED utilization. Methods: We conducted a review of administrative data at Brigham and Women’s Hospital (BWH) that serves as the ED for patients undergoing cancer treatment at the Dana Farber Cancer Institute. We identified oncology diagnosed patients that presented to the ED between 9/1/2011 and 9/30/2012 (n=6,035 unique visits). We focused our analysis in those patients ultimately discharged home, directly discharged (Home n=1647) or after an ED observation stay < 24 hours (ED Obs n=379) to evaluate opportunities for improvement. We then reported charges, cancer type, primary ED discharge ICD-9 code, and tests ordered per ED visit by disposition status. Results: We found that 34% of the ED encounters (n=2,026) were ultimately discharged home (directly discharged or after an ED observation stay). Among them, the average charge per visit for these patients varied from $3,304 (SD= 2,734) for Home to $10,951 (SD= 6,540) for ED Obs. 73% (n=1,473) of these patients had solid tumor diagnoses. The five most common solid tumor diagnoses associated with these patients were gastrointestinal (16%), gynecologic (12%), genitourinary (10%), breast (10%), and thoracic (9%). The most common ICD-9 codes associated with these patients’ admissions were abdominal pain (9%), fever (5%), dyspnea (5%), chest pain (3%), and nausea (3%). Of these outpatients, 53% (n=1,066) had at least one radiologic test performed, the most common tests being chest x-ray in 41% and CT scans in 16%. Conclusions: About 1 in 3 cancer patients who present to the ED are not admitted to an inpatient setting, representing potentially avoidable costly ED visits. Most of these patients are represented by five solid tumor diseases. Improved alternative outpatient access and management strategies of symptoms such as abdominal pain, dyspnea, and nausea in these patients may reduce ED utilization in this patient population.
Automating a program for the evidence-based reimbursement of oncology drugs across a complex network: Benefits and challenges.
Authors: Gilks John , Yurcan Marta , Yardley Tim , Gavura Scott , Kukreti Vishal
Published: February 2017

39

Background: Ontario hospitals are reimbursed for IV chemotherapy through Cancer Care Ontario’s (CCO) New Drug Funding Program (NDFP). By 2009, 54 indications (annual budget $195MM) were managed through largely paper based processes. A new web based system (eClaims) was developed focusing on clinic workflow and integration to chemotherapy ordering systems. Interfaces were developed for CCO’s OPIS and commercial systems (HL7v3). eClaims provides users with clinical best practice, pre-approval, immediate adjudication and simple means of tracking outstanding claims. The benefits and challenges are described. Methods: Evaluation used several strategies: debriefs after each deployment; post-go live user surveys and lessons learned workshops. Results: eClaims was deployed in 80 hospitals over two years. At most sites (50/80) treatment data flows from CPOE systems to eClaims in near real time. Over 50% of claims are machine adjudicated. Newly approved indications can be posted within hours. The main learnings during the deployment process were the need to understand and adjust for hospital specific factors and the unique business relationships among clusters of hospitals. Survey responses were received at a 19% response rate. The later deployment groups reported greater satisfaction than earlier adopters with more positive responses in all categories. Workshop key theme was the need to match complex clinical workflows with design/build processes. Secondly, evaluation of historical data before migration is necessary. Conclusions: Introducing an application into complex, varied clinical workflows is difficult. The phased approach to deployment and evaluation worked, allowing for increasingly smooth go lives. Future work revolves around balancing user needs through eClaims modifications vs simplifying clinical processes to make the tool more usable.
Highmark and Allegheny Health Network: Partners in Quality Oncology Practice Initiative (QOPI) measures automation reporting.
Authors: Bird Kyle
Published: February 2017

41

Background: ASCO’s QOPI Participation and Certification processes pose a daunting operational task for oncology practices nation-wide. The standardization and quality improvement initiatives required for Certification involve multiple constituents and often a longitudinal approach to quality and operations management. The human resources required for biannual abstraction can be burdensome given strained resources in an increasingly complex reimbursement environment. Allocating staff for retrospective medical record review requires a steep QOPI learning curve and time away from the clinic. The Allegheny Health Network and Highmark, the Nation’s tenth largest insurer, have partnered to create a monthly QOPI measures automation report which alleviates the burden of a purely human resource-based abstraction methodology. Additionally, 100% of Highmark insured, Allegheny Health Network QOPI qualifying patients are included in a monthly report to allow for near real-time clinical decision support. Methods: A multidisciplinary team was assembled with clinical and administrative representatives from Highmark and Allegheny Health Network. The team worked together in phase I of the project for over eight months to review and select specific QOPI measures that could be tracked through a custom-built, claims processing algorithm. Results: Initial data analysis included over seventy-five automated QOPI measures that would be able to be tracked and trended on a monthly basis – populated from Highmark claims data. The monthly report allows for a larger sample size with data tracking across all QOPI domains and disease sites. The multidisciplinary team has moved on to phase II of the project which will include sensitivity analyses and data refinement. Conclusions: QOPI measures automation is possible through an evolving relationship demonstrated through this unprecedented payer/provider initiative. While some of the QOPI reporting measures could be automated, human resources will still be required for annual abstraction in the on-going QOPI Certification phase. Once refined, automated measures will need to be verified to note changes in claims data and clinical documentation.
Moving toward patient-based funding through quality-based procedures (QBPs) for GI endoscopy and colposcopy.
Authors: Ratansi Nabeela , Langan Aimee , Blais Irene , Svara Erin , Houser Karla , McCurdy Bronwen , Moffatt Jessica , Elliott Lori
Published: February 2017

43

Background: As part of the Ministry’s Health System Funding Reform initiative, Cancer Care Ontario is tasked to develop and implement Quality-Based Procedures (QBPs) for programs such as GI Endoscopy and Colposcopy. QBPs are clusters of patients with clinically related diagnoses or treatments that have been identified by an evidence-based framework as providing opportunity for improving quality outcomes and reducing costs. As stated by the Ministry, the goal is to reimburse providers for the types and numbers of patients treated, using evidence-informed rates associated with the quality of care delivered. Methods: QBPs are multiyear and have four key deliverables: Clinical: developing clinical best practices. Funding: tying best practices to pricing. Capacity Planning: understanding procedure types/volumes for capacity management. Monitoring/Evaluation: measuring the QBP’s impact. Developing the QBPs has involved: Creating Clinical Expert Advisory Groups (CEAG) of clinicians who are recognized for their knowledge and expertise. Tasking the CEAG to define quality and develop best practices informed by literature reviews, jurisdictional scans, and guidelines. Documenting these standards and clinical pathways in a clinical handbook, providing information on the practices that should be implemented to ensure consistent care delivery. The development of best practices is imperative to the foundation of the QBP and spans multiple years. Once best practice development is complete, it will be tied to pricing, where the procedure will be micro-costed based on workload, equipment, supplies, and other administrative costs. Results: The QBPs continue to evolve and aim to: Reduce practice variation. Improve patient outcomes. Improve system accountability. Improve cost-effectiveness of services. Effectiveness will be measured through a performance management framework, including an integrated QBP scorecard measuring appropriateness, access, and efficiency. Conclusions: The underpinning for moving towards an evidence-based, patient-based funding model involves defining quality standards and clincal best practices, and applying these guidelines to determine the cost of quality care.
Evaluating the confluence of oncology market trends and key levers to drive payment and delivery reform for treatment of multiple myeloma.
Authors: Waltersdorf Jenna , Barnes Lauren G. , Hussain Fauzea , Mitchell Kristi
Published: February 2017

45

Background: A multi-factorial focus on treatment costs and the incremental improvement in outcomes has accelerated interest in payment and delivery reform in oncology, specifically a shift from fee-for-service to fee-for-value. As the landscape continues to evolve, there are key levers that will accelerate reform for specific cancer types. Our objective was to examine how broad oncology market trends and key levers for multiple myeloma (MM) intersect to drive payment and delivery reform. Methods: We evaluated 18 oncology market trends, classified the pervasiveness of each as nascent, emerging, or widespread, and assessed trends for specificity to MM compared to other cancers. We then evaluated six key levers that, within the context of each trend, may ripen MM for payment and delivery reform. Levers included 1) national guidelines; 2) quality measures; 3) prevalence/incidence relative to other cancer types; 4) advanced imaging or other high-cost treatment expenditures; 5) drug/biologic contribution toward treatment costs; and 6) approved companion diagnostic(s). Results: While some guidelines exist to address treatment of MM, there are gaps in recommendations that do not address the full continuum of care to guide physician decision making, giving this lever low influence to drive reform. One measure for quality improvement has been used at a broad national level, giving this lever moderate influence on reform. Today, characteristics of MM that trigger key levers make MM an unlikely focus for widespread reform initiatives. Conclusions: Most oncology market trends are cancer-type agnostic, but trend pervasiveness and their confluence with key levers will dictate the shape of alternative payment models for changes to treatment delivery and reimbursement. By developing additional quality measures and addressing guideline gaps, stakeholders may further trigger two key levers to ripen MM for payment and delivery reform. Reform initiatives may be expedited as additional treatment options are introduced to the market, and as stakeholders work to influence key levers and evaluate the feasibility for and implementation new payment and delivery models for MM.
Advanced radiation oncology technology within the Veterans Health Administration (VHA).
Authors: Dawson George A. , Cheuk Alice V. , Jolly Shruti , Gutt Ruchika , Fosmire Helen , Lutz Stephen T. , Anscher Mitchell Steven , Hagan Michael Philip , Moghanaki Drew , Hoffman-Hogg Lori , Kelly Maria D.
Published: February 2017

52

Background: The rapid evolution of technology in the treatment of cancer has paralleled other technological advancements in modern society. Intensity Modulated Radiotherapy (IMRT), Image Guided Radiotherapy (IGRT), Brachytherapy (BT), Cone Beam Computed Tomography (CBCT), Stereotactic Radiosurgery (SRS), and Stereotactic Body Radiotherapy (SBRT) facilitate treatment with higher, more conformal radiation doses, potentially improving cancer control while reducing normal tissue toxicity. Recent Surveillance, Epidemiology and End Results (SEER) program data and physician surveys indicate prostate BT is declining and the integration of SRS and SBRT is slower compared to IMRT. As utilization of technology increases, an understanding of its availability within the VHA is necessary to ensure quality and patient safety. Methods: An electronic survey was sent to 82 Radiation Oncologists (ROs)at 38 active VHA Radiation Oncology Centers with subsequent follow-up phone calls. The survey occurred from May-June 2014. ROs were queried on the availability of advanced RT technologies including IMRT, IGRT, BT, CBCT, SRS and SBRT at their facility. Practitioner specific details: years in practice, academic appointment and VHA employment status were collected. Results: Responses were obtained from 62 ROs representing 75% of VHA ROs and 34 or 89% of facilities. Full time VHA employees made up 60% of respondents with 35% in practice for <5 years and 34% practicing for >20 years; 71% held an academic appointment. The Table shows on site availability of advanced RT technologies within the 34 VHA sites that responded. Conclusions: For veterans receiving cancer treatment, VHA ROs are able to routinely use IMRT and IGRT with CBCT capabilities. However, stereotactic (SRS and SBRT) and BT services are less available, and may require referrals externally or to other VHA facilities. Limited availability of SRS and SBRT parallels the community experience. Likewise the decreasing utilization of BT is common to the VHA and private sector. SBRT, SRS and BT require significant expertise and technology. [Table: see text]
Quality breast screening begins with quality technologists: Exploring workplace satisfaction among mammographic technologists.
Authors: Marsh Katie , Benefield Thad , Durham Danielle , Bowling J. Michael , Henderson Louise
Published: February 2017

53

Background: To provide a quality patient experience, radiologists depend on the technologists’ skillset and interactions with patients, both of which may be impacted by satisfaction in the workplace. We identified factors related to the technologists’ job satisfaction, separately for lead and non-lead technologists. Methods: We sent a 50-item survey to 912 mammographic technologists (238 lead and 674 non-lead) throughout North Carolina. Survey items included questions on education and training, work experience, interaction with radiologists and other technologists, and job satisfaction. Job satisfaction was based on a 5-point scale ranging from 1 (strongly agree) to 5 (strongly disagree) for questions on workplace decision making and control, supervisor support, and performance feedback. Using a regression tree analysis, we identified factors related to technologist job satisfaction. All variables significant in the regression tree analysis (p-value<0.05) were included in a linear regression model. Results: A total of 433 mammographic technologists responded to the survey (response rate 47.5%; 95% CI 44.2-50.7). Of these, 128 were lead (response rate 53.8%; 95% CI 47.4-60.1) and 305 were non-lead (response rate 45.3%; 95% CI 41.5-49.0). The mean job satisfaction among lead and non-lead technologists was 1.96 (SD 0.72; range 1 to 4.25). Linear regression analyses revealed that for lead and non-lead technologists, hours of administrative work (p<0.0001), having frequent communication with radiologists (p=0.01), and having a mentor in the workplace (p=0.002) were related to increased job satisfaction. Being a lead technologist was associated with higher job satisfaction (p=0.0004). The number of diagnostic mammograms performed per week was inversely related to job satisfaction for lead technologists (p=0.002). Conclusions: There were little differences in factors that influence mammographic technologists’ job satisfaction for lead versus non-lead technologists. Future studies should explore if technologists’ job satisfaction affects recall rates and patient perceptions of quality care.
Quality indicators of end-of-life cancer care: What rate is right?
Authors: Barbera Lisa Catherine , Sutradhar Rinku , Burge Fred , McGrail Kim , Fassbender Konrad , Lawson Beverley , Pataky Reka , Potapov Alex , Peacock Stuart , Chu Anna , Liu Ying , Seow Hsien
Published: February 2017

57

Background: Many publications use administrative health care data to describe quality of care indicators at the end of life (EOL). However, very little is available to help decide on optimal rates for these indicators. The purpose of this abstract is to develop data-driven and achievable benchmark rates for EOL quality indicators using administrative data from 4 provinces in Canada. Methods: Five quality indicators of EOL care were defined and measured using linked administrative data for each of the 33 regions across British Columbia, Alberta, Ontario and Nova Scotia. These were: emergency department (ED) use, intensive care unit (ICU) admission, physician house calls (MD) and nursing visits at home (RN) prior to death, and death in hospital (DH). First, an empiric benchmark was defined by determining indicator rates among the top ranked regions to include the top decile of patients overall. Second, funnel plots were used to graph the age and sex adjusted indicator rates for each region along with the overall average value and 95% confidence limits (CL) that accounted for region size. Results: There was significant variation in rates for each indicator among the regions. Minimum and maximum rates for ED, ICU, RN, MD and DH varied approximately 2 to 4 fold across the regions with MD showing the greatest variation. Benchmark rates based on the top decile performers were: ED 34%, ICU 2%, MD 34%, RN 63%, DH 38%. With the exception of ICU, funnel plots demonstrated that mean indicator rates and their 95% CL were uniformly worse than these benchmarks even after adjusting for age and sex. Additionally, few regions met the benchmark rates. Conclusions: There is significant variation in EOL quality indicators across regions in 4 provinces in Canada. The combination of these two methods allows each region to determine its performance relative to both a benchmark and the overall average. As a result, each region is then able to gauge their performance with greater context which facilitates priority setting and resource deployment. These two methods demonstrate how decreasing variation and striving for a target can drive quality improvement. Deriving benchmark values from ‘real world’ data offers the advantage of realistically achievable targets.
The effectiveness of the shared medical visit among patients with a gynecologic malignancy undergoing chemotherapy along the Texas-Mexico border.
Authors: Castañeda Kayla E. , Hernandez Loretta L. , Mulla Zuber , Greenberg Harvey , Saldivar J. Salvador
Published: February 2017

63

Background: The goal of this program was developed in response to The Institute of Medicine’s (IOM) “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001) to provide patient-centered care that would result in improved patient satisfaction and decreased stress through the use of a shared medical visit (SMV) for patients with a gynecologic malignancy undergoing chemotherapy in place of an individual visit. Methods: The study design was a prospective cohort at a university health sciences center located on the Texas-Mexico border. A total of 20 patients will be enrolled in the SMV and 20 in the individualized visit. Participants attended group sessions with the provider that combined assessment, education, and social support. Patient-centered care was achieved by assisting them to obtain their own vital signs and by using a facilitative learning approach during the educational and social support component. Patients in the comparison group were patients who continued in the individual visits. The average differences between the pre- and post-session scores for perceived stress and patient satisfaction were calculated for both groups. Differences between both patient groups were tested for statistical significance using the Student’s independent two sample t-test. Results: The first twelve patients completed pre- and post-session questionnaires on perceived stress and patient satisfaction. For perceived stress, a lower score indicated lower stress. The average change in score for the individual group (n=6) was 0.67, and the average change in score for the SMV group (n=6) was -2.83 (p=0.28). For patient satisfaction, a higher score indicated higher satisfaction. The average change in score for the individual group (n=6) was -5.5; the average change in score for the SMV group (n=6) was -7.5 (p=0.80). Conclusions: Overall, patients felt they benefited from the shared medical visit. While the results of our interim analyses were not statistically significant, it appears that patient stress with the shared medical visit model may decrease over time. Based on our preliminary results we will continue to enroll patients and evaluate this unique program.
Involving patients to improve their care through real-time patient reported outcome (PRO)-CTCAE chemotoxicity surveys in an outpatient chemodaycare (DC) setting: Evaluating patient acceptability.
Authors: Solomon Hannah , Brown Catherine , Vennettilli Ashlee , Zarrin Aein , Dobriyal Aditi , Chen Linda , Pat Vivien , Ho Anthea , Xin Cindy , Irwin Margaret , Wang TIan Qi , Gonos Christina , Merali Zahra , Wong Lauren , Xu Wei , Howell Doris , Liu Geoffrey
Published: February 2017

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Background: In a busy DC setting, the efficiency of identifying important treatment toxicities is essential to quality care. Using a systematic approach to collecting patient-reported outcomes in the waiting rooms of DC units is one possible means of improving care while involving patients. This study reports such a pilot study, and the associated assessment of patient acceptance of this approach. Methods: 156 cancer patients over the age of 18 receiving chemotherapy treatment at Princess Margaret Cancer Centre completed a patient-reported chemotoxicity assessment using PRO-CTCAE items on tablet technology. Main symptoms assessed were: fatigue, nausea and vomiting, diarrhea and constipation, pain, aching muscles and/or joints and dysgeusia. Patient’s perception on the usefulness of PROMs and their willingness to complete such a tool routinely was assessed. Results: The median age was 53.5 (range: 19-88 years), 38% were male and 66% were Caucasian. Over 80% did not find the survey overly time consuming (or made their visit more difficult). Less than 1% were distressed by the survey questions. Over 80% reported that the survey asked the appropriate questions. While 81% considered the PROMs useful in informing their physician of their symptoms, 25% reported they would not be willing to complete the survey at each clinic visit. Another 25% were unsure of their feelings toward this approach. 93% were happy to complete the survey using tablet touchscreen technology. Conclusions: Most patients found the survey method of self-reporting one’s symptoms to be acceptable, non-distressful, and an important practice. From the patient perspective, the process of reporting one’s symptoms using tablet touchscreen technology is both simple and feasible.Yet, only 50% of patients would be willing to complete this survey at every clinic visit. Additional mixed-methods analysis looking at patient characteristics associated with acceptance/non-acceptance and willingness to complete the survey on a regular basis is ongoing and will be reported at the conference.
Evaluation of a system-level organizational approach to person-centered care education and implementation toolkit.
Authors: Moody Lesley , Shamji Hannah , Green Esther , Macdougall Laura , Peek Naomi , Singh Simron
Published: February 2017

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Background: Cancer Care Ontario (CCO) is an Ontario government agency which drives quality and improvement in the delivery of care and the patient experience for the Ontario cancer system. Person-Centred Care (PCC) has been identified as a goal from the recent Institute of Medicine (IOM) report and as a corporate strategic priority at CCO. As an initial step in a province-wide PCC strategy, CCO is developing and internally disseminating a patient engagement toolkit and eLearning module with expansion to regional cancer programs. Methods: The PCC eLearning module defines the care approach and explains the corporate goals and objectives of practicing PCC at CCO. Pre- and post-evaluation metrics are embedded to measure module impact on a rating scale with respect to: (1) understanding of PCC; (2) willingness to include the patient voice in CCO work; and (3) understanding of the role of patients who serve as advisors at CCO. The Patient Engagement Toolkit was developed as a step-by-step guide on why and how to engage Patients and Family Advisors (PFAs) in different organizational contexts. To test effectiveness and impact, we piloted the toolkit in 6 interactive sessions across 7 departments with 184 CCO employees over 2 months (Clinical Program and Quality Initiatives, Regional Program, Communication, Finance/Procurement/Facilities, HR, Business Analyst/Project Management Office). We are taking a comprehensive mixed methods evaluation approach with online surveys and key informant interviews to identify uptake and barriers. Results: Preliminary findings suggest considerable increase in the understanding of PCC and the role of PFAs at CCO, with 138 current instances of patient engagement in 1 quarter. After an introduction to the toolkit, many employees (86.7%) understood the value of engaging PFAs and most (63.7%) felt willing to start. Conclusions: Initial program evaluation demonstrates an increase in the understanding and implementation of direct (e.g., joining committees/working groups) and indirect PFA engagement (e.g., speaking at events/in focus groups) across CCO departments. Further evaluation of the toolkit at a provincial level is needed.
Assessing person-centered care readiness at a cancer system level through a provincial environmental scan in Ontario.
Authors: Moody Lesley , Navarro Jorge , Green Esther , Macdougall Laura , Singh Simron
Published: February 2017

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Background: Cancer Care Ontario (CCO) is an Ontario government agency which drives quality and improvement for the Ontario cancer system. Person-Centred Care (PCC) has been an identified goal both from the recent Institute of Medicine (IOM) report and as a corporate strategic priority at CCO. CCO is assessing the degree of PCC practiced in Ontario’s Cancer system to design interventions to improve this aspect of care delivery and design. Currently no established or validated indicators for PCC have been tested and evaluation methodology of PCC is unclear. A baseline of the system’s focus on PCC is required to establish a provincial plan to drive quality improvement. Methods: A series of 14 semi-structured interviews were conducted at Ontario’s regional cancer centers (RCCs) to determine the degree of development of a PCC culture in Ontario’s cancer system. Interviews were conducted with all 14 Regional Cancer Programs (RCPs) including: - 10 Patient and Family Advisors (PFAs); and - 56 RCPs and hospital leaders (Directors, Managers, Physicians, Nursing, Psychosocial Oncology providers). Sixty-six participants (direct interviews/questionnaires) were interviewed; questionnaires were received from 28 organizations (hospitals/RCCs). Results: Although 86% of interviewed organizations reported having a PCC corporate strategy, 41% of hospitals and 73% of RCCs do not have dedicated staff to support the strategy. 53% of organizations work with a Patient and Family Advisory Council (PFAC) and only 43% engage PFAs in decision-making tables with 94% of RCPs expressing a need for guidance on PFA engagement. Key facilitators to promote PCC are: strong and committed leadership and continuous staff engagement/education. Primary barriers include: equity in PFA recruitment, cultural resistance to PCC, and lack of evaluation frameworks. Conclusions: Advancing PCC requires strong provincial direction, training to foster PFA engagement, and measurement and accountability frameworks for cultural change. Clear definitions on accountabilities for PCC roles and expectations for PFAs and staff are also key to supporting PCC regionally.
Demographic trends in clinical trial withdrawal rate within the Bubble Study: Updated analysis.
Authors: Riley Elizabeth Carloss , Dragun Anthony E. , McMasters Kelly , Quillo Amy R. , Scoggins Charles Raben , Wu Xiaoyong , Rai Shesh , Jain Dharamvir
Published: February 2017

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Background: There are well described barriers to clinical trial participation among varied racial/ethnic and demographic groups. Little is known about clinical trial drop-out rate among these groups. This is an updated analysis of the demographic and clinical characteristics of patients who originally enrolled in the “Bubble Study” clinical trial but then withdrew at a later date. Bubble Study is a non-blinded, prospective observational cohort study designed to assess the adherence rate of adjuvant endocrine therapy among women with early stage breast cancer. Methods: From Aug 2012 to April of 2014, 88 women were enrolled. Demographic data (age, race. insurance status) and treatment factors (stage, surgery type, therapy duration, co-morbidites) were collected. Comorbidities were defined as none, moderate (1-3) or significant (>3.) Descriptive statistics were produced for the entire cohort and the subjects of cohort. Frequencies were compared using a Chi-square test (Fisher’s exact test when expected cell frequencies are small). Results were declared significant at significance level of 5% and all analyses are performed using SAS (2003, 2005). Results: At the time of analysis, 86 patients enrolled (E), 41 of which withdrew (W.) Blacks represented 21% of the total E. Private insurance represented the majority (60.4% of those E and Medicare, Medicaid and Uninsured followed in that order (24.4%, 14% and 1.2% respectively.) There was no significant difference with regards to race and insurance between the E and W group although there was a trend toward a higher rate of W among Blacks (p=0.21). Stage, surgery type or age did not predict for W. Comorbidites had a marginal effect on W (p=0.02) The most common reasons reported for W were financial and/or insurance reasons (22%) and inconvenience of pharmacy pick up (15%.) Conclusions: Demographic characteristics that traditionally predict for under-representation in clinical trial enrollment did not predict for W from the Bubble Study. Although this sample size is small this data may suggest disparities in clinical trial participation are largely due to enrollement rather than withdrawal. Continued analysis of this trial and others will help confirm these findings. Clinical trial information: NCT01694225.
Hearing the patient’s voice: Utilization of a patient-family advisory group in key cancer care initiatives.
Authors: Franco Theresa , Yager Ann
Published: February 2017

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Background: As patient participation and satisfaction move to center stage in defining quality care experience and providing a competitive edge, it has become necessary to develop strategies to secure patient input and engagement in strategic care initiatives. Methods: At the Nebraska Medical Center, a cancer patient advisory group was established to create a better understanding of the patient experience through the lens of the patient/family member. Our goal focuses on the 3 'P's"- people, processes, and places to improve the patient/family cancer experience. Participants were selected through an application/ interview process from a variety of diseases, backgrounds, and ages to represent a broad spectrum. Results: Initially the group provided feedback on educational formats, throughput, and communication methods. Our greatest opportunity to utilize this advisory group emerged in design and development of the Fred and Pamela Buffett Cancer Center. This 570,000 square foot facility includes a research tower as well as multi-disciplinary inpatient and outpatient clinical environments. Knowing this project would be transformational in cancer care delivery, it was critical that patient input be considered in every phase of design and process improvements. The patient advisory group became instrumental for exploring ideas ranging from the initial impression of the lobby, inpatient, infusion, and exam room layouts, to critical amenities, and way finding, signage. Input on equipment, furniture and technology choices was also sought. Their feedback, obtained through multiple venues, has become instrumental in driving change to enhance our care experience. These interactions have resulted in significant design modifications, a greater emphasis on efficiency in care, and the infusion of elements that individualize the cancer care journey. Conclusions: Engaging the patient advisory group has been critical in in advancing both current and future care initiatives. The health care team has benefitted, by creating a greater awareness of the most coveted aspects of a patient/family experience. It is a powerful conduit for hearing the patient’s voice and putting their words into action.