bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a ride share program for patient transportation home from a hospital admission.
Authors: Lightheart Erin , Kucharczuk Colleen 
Published: October 2020

243 Background: This quality improvement project takes place within a large hospital, on a team that manages about 1700 oncology discharges per year. The hospital emphasizes the importance of discharging patients early in the day to encourage more efficient patient flow. On advanced medicine units within the hospital, 19% of discharge delays were reported as stemming from transportation issues related to family being delayed. Methods: A multidisciplinary group utilized a ride share company to implement a HIPPA compliant transportation program. Upon admission, each patient was screened for potential transportation barriers by a coordinator. Patients outside of a 35-mile drive from the hospital were excluded. Patients who expressed a concern about reliable transportation were offered enrollment. The patient completed a consent form, agreeing to be texted by the company with logistical information about their ride. At the end of the patient’s stay, the coordinator scheduled a “will call” ride within the vendor’s electronic system, which could then be activated by the patient via phone upon discharge. The coordinator tracked each patient’s barriers along with an estimated number of hours saved. Results: The average time saved per patient was 5.3 hours and, at peak, the average number of rides per month was 36. The estimated additional capacity created was 7.2 patients annually. About 14% of transportation barrier screenings resulted in a ride being scheduled. Of the patients that declined, 53% preferred to travel with family or friends, 28% were excluded due to distance, 10% were too ill to utilize the service, and 8% declined for other reasons. Conclusions: The intervention provided clear value to the institution and the patient, and the organization is now exploring a system-wide ride share transportation program. The team identified an untapped opportunity in using the program for admissions. Suggested patient populations for expansion include patients leaving the Emergency Department, those with fairly predictable lengths of stay, such as gastrointestinal surgery patients, and populations of relatively lower acuity since they are more likely to be well enough to get into their home without assistance. [Table: see text]
Care redesign of pelvic radiotherapy using Design Thinking: An enhanced quality improvement initiative.
Authors: Ho Cho Hao Francis , Tey Jeremy Chee Seong , Ooi Kiat Huat , Tan Teng Hwee , Leong Yiat Horng , Chia David 
Published: October 2020

246 Background: Cone Beam Computed Tomography(CBCT) is the cornerstone of image guided radiotherapy(IGRT) which is an integral part of pelvic cancers like prostate cancer. Each pelvic radiotherapy (RT) session is preceded by a planned CBCT to ensure target localisation and organ at risk avoidance. When these criteria are not met, an unplanned CBCT is performed until the CBCT is satisfactory. Possible reasons for an unsatisfactory CBCT include an under filled bladder, distended rectum or prostate gland movement. Repeated unplanned CBCT results in unnecessary excess radiation for patients. We aimed to reduce the incidence of unplanned CBCT from a baseline of 21% to 9% over 5 months. Methods: We conducted the project using both conventional quality improvement methodology and the design thinking methodology. In the diagnostic phase up to March 2017, the baseline incidence of CBCT in patients receiving pelvic RT was 21%. We hypothesized that there were reversible factors leading to a higher incidence of unplanned CBCT and sought to identify and rectify these reversible factors to reduce the incidence of unplanned CBCT. Using human centred design, we designed a new process of performing a bladder ultrasound prior to CBCT to ensure a full bladder prior to RT using the steps empathy, define, ideation, prototype, testing, sharing. Results: A total of 97 patients that underwent pelvic radiotherapy were included in this study, 40 patients were pre intervention and 61 patients received the bladder ultrasound intervention implemented from April 2017 onwards. After intervention, incidence of unplanned decreased from 21% to 5.8%. A 2 sample t test was used to compare the unplanned CBCT pre and post intervention. We found the mean pre and post intervention difference in pooled mean incidence of unplanned CBCT to be significantly different by 13.3%. The reduction in unplanned CBCT translated to saving each patient on average equivalent to 3000 chest x rays worth of unnecessary radiation. Conclusions: Design Thinking is a feasible strategy in quality improvement. We report the first design thinking project in radiation oncology quality improvement. An automated ultrasound bladder is a feasible strategy to screen for bladder filling prior to each CBCT to reduce reliance on CBCT and also patient exposure to radiation in IGRT of pelvic cancers.
Impact of a built-in electronic medical record prompt on guideline-recommended prophylactic antiviral usage in patients with multiple myeloma receiving proteasome inhibitors.
Authors: Young Garrett , McCullough Stacey , Arrowsmith George , Lyss Aaron J. , Schleicher Stephen Matthew , Dickson Natalie R. , Arrowsmith Edward 
Published: October 2020

248 Background: Guidelines support the use of prophylactic antivirals to prevent reactivation of herpes varicella in patients with multiple myeloma (MM) on proteasome inhibitors (PI). In our network of five oncology practices spanning over 100 clinic sites, one practice has a built-in prompt for acyclovir use in patients receiving a PI, while the other four practices do not. We used this natural experiment to determine the impact of this prompt on appropriate prophylactic antiviral usage in this patient population. Methods: We retrospectively identified all patients in our network with MM beginning a regimen containing a PI between 1/1/19 and 5/28/20. Of these patients, we identified those with documentation of a prescription for acyclovir or valacyclovir before or within 2 days of the first PI dose. We compared prophylactic usage across five practices. Practice 1 had built a prompt for the prescription of acyclovir in regimens containing bortezomib or carfilzomib within the electronic medical record (EMR) which both reminded physicians and nurses and simplified the prescribing process. No other practices had similar EMR prompts. Results: We identified 583 patients with MM who received a PI during the study period. Wide variation in rates of prophylactic antiviral usage existed across the five practices (range 21%-94%). The highest rate of prophylactic antiviral usage was practice 1 (94%). This was the only practice with a built-in EMR prompt for acyclovir usage in PI regimens. We found no association between use of prophylactic antivirals and individual provider-level volume of patients with MM. Conclusions: Use of prophylactic therapy is heterogeneous across practices. A comprehensive treatment plan containing a prompt in the EMR can markedly increase appropriate utilization. We plan to add an EMR prompt and analytics-driven reminders across our network to improve utilization of all guideline-recommend, orally administered prophylactic medications. [Table: see text]
Adverse event clusters present at dose-reduction in CLL patients on ibrutinib in the U.S. Veterans Health Administration.
Authors: Frei Christopher R , Ryan Kellie , Le Hannah , McHugh Daniel , Obodozie-Ofoegbu Obiageri O , Teng Chengwen , Jones Xavier , Galley Samantha , Franklin Kathleen , Tavera Juan , Janania Martinez Michelle , Gregorio David , Ananth Snegha , Uribe Ricardo , Surapaneni Prathibha , Espinoza-Gutarra Manuel Ricardo , Song Michael , Nooruddin Zohra 
Published: October 2020

252 Background: Previously, we reported that adverse events (AEs) were the top reason for dose reductions in VHA patients on novel agents. Some AEs might be problematic but might not directly lead to dose reduction; however, these concomitant AEs should not be overlooked. This study describes AE clusters that occurred with the primary AE that led to dose reduction in VHA CLL patients receiving ibrutinib. Methods: This is a retrospective chart review study of CLL patients treated with ibrutinib in the VHA from October 2013 to March 2018. Variables included the presence of dose reduction, the reasons for dose reduction, primary AEs leading to dose reduction, and concomitant AEs present at the time of dose reduction. Descriptive statistics were used to summarize AE clusters. Results: Out of 1069 CLL patients on ibrutinib, 285 patients experienced dose reduction due to AEs and were included in this analysis. The most common AEs leading to dose reduction were: musculoskeletal (11%), bleeding (11%), fatigue (10%), infection (9%), atrial fibrillation (8%), diarrhea (8%), and rash (8%). Fatigue was the leading concomitant AE present at dose reduction among patients who were dose reduced due to musculoskeletal (18%), infection (12%), diarrhea (18%), and rash (25%). Fatigue was also the second-leading or third leading concomitant AE among those who were dose reduced due to atrial fibrillation (13%) or bleeding (10%). Musculoskeletal was the leading or second-leading concomitant AE present at dose reduction among those who were dose reduced due to fatigue (17%), infection (12%), or diarrhea (14%). Bleeding was the leading concomitant AE among those who were dose reduced due to atrial fibrillation (17%) and vice versa. Conclusions: This study provides evidence that fatigue and musculoskeletal AEs are problematic in CLL patients on ibrutinib in the VHA. These were not only among the most common primary AEs but also the leading concomitant AEs present at dose reduction. Although not directly leading to dose reduction, these ‘nuisance’ AEs can greatly affect quality of life among CLL patients and warrant more attention from clinicians. A better understanding of all AEs present at dose reduction may help clinicians better manage patients on novel agents. These data also highlight the unmet need for novel agents with a ‘cleaner’ safety profile.
Use of antiemetic prophylaxis and oral breakthrough medication for highly emetogenic chemotherapy (HEC) in a large community oncology network.
Authors: Young Garrett , Schleicher Stephen Matthew , Arrowsmith Edward , McCullough Stacey , Richey Sylvia S. , Blakely Johnetta , Dickson Natalie R. , Schwartzberg Lee S. 
Published: October 2020

253 Background: Prophylaxis for highly emetogenic chemotherapy (HEC) is well established in clinical guidelines, but real-world treatment patterns are unclear. Today, consistent use of prophylaxis is more easily accomplished due to the incorporation of ordering premeds into the workflow prior to administration of intravenous chemotherapy. However, prescription of oral agents for treatment of breakthrough chemotherapy induced nausea and vomiting (CINV) is less consistent and standardized and has a scant evidence base. In an effort to standardize utilization, we evaluated the use of prophylaxis and oral breakthrough medications in a large national community oncology network. Methods: Data from electronic medical records at five practices comprising over 100 clinic sites was analyzed to examine the frequency of guideline-recommended triplet 5-HT3 receptor antagonist, NK-1 receptor antagonist, and corticosteroid use for prophylaxis prior to the administration of HEC agents. Oral breakthrough medication use and preference was also analyzed. Data was collected and analyzed at the practice level. Results: We identified 2645 patients that received HEC between 1/1/2019 and 5/8/2020. We found consistently high utilization of guideline-concordant triplet prophylaxis regimens for patients receiving HEC, ranging from 90-100% at each of the five practices. In addition, most patients (mean 83%, range 67% - 94%) received a prescription for at least one oral breakthrough medication, but the agent(s) utilized varied widely across practices (Table). Ondansetron was the most commonly prescribed oral breakthrough medication (mean 68%, range 53% - 88%), while olanzapine use for either prophylaxis or breakthrough CINV across practices ranged from 1% - 4%. Conclusions: In this national community oncology network, standard recommended triplet agent prophylaxis for HEC was delivered successfully. However, opportunity exists to increase appropriate use of olanzapine and reduce variation of oral breakthrough antiemetic medications in order to optimize clinical care. [Table: see text]
The role of telehealth in improving patient care and satisfaction during a pandemic: University of California Cancer Consortium experience.
Authors: Cinar Pelin , Burgess Debra , Gold Kathryn A. , Yamamoto Maki , Ternavan Kimberly A. , Kamiya Emi 
Published: October 2020

258 Background: The adoption of telemedicine in providing patient-centric care has been limited due to concerns related to upfront cost and the uncertain reimbursement models. Telehealth modalities, which encompass broader services, quickly became a central focus of how we delivered care in cancer centers across the nation during the COVID-19 (C19) pandemic. Our aim is to describe five University of California (UC) Cancer Centers’ experience with telehealth during the pandemic. Methods: Between March and June 2020, UC Cancer Centers developed or increased the use of telehealth modalities to continue to provide care to our oncology patients during the pandemic. Digital platforms were used to screen for symptoms and exposures related to C19, as well as for symptoms of distress. In addition, providers performed remote visits via video and telephone visits. Each of our centers monitored visit volumes as well as patient satisfaction scores during the pandemic. Results: Our Cancer Centers, each with various levels of pre-pandemic (Jan-Feb) use of telehealth, saw an increase in the volume of patients who were seen via remote visits including video and telephone visits during the pandemic (Mar-Apr). UC Davis, UC Los Angeles and UC San Francisco had implemented telemedicine prior to the pandemic, but the rates of use were 1%, 0.4% and 7%, respectively. In contrast, UC Irvine and UC San Diego did not offer remote visits prior to the pandemic. Despite these differences, during the pandemic, telemedicine rates increased to 50-70% of visits in the cancer centers. In addition, patient satisfaction scores were comparable to in-clinic visits. The use of digital platforms allowed 80% of patients to be screened for risk of C19 prior to their in-clinic visits. Conclusions: While differing levels of implementation was in place for telehealth services in our cancer centers prior to the pandemic, each cancer center was able to continue to see patients via remote visits. In addition, telehealth technology automated activities that would have been performed manually pre-pandemic. The increased use of telemedicine visits with high patient satisfaction scores is an indication that some patients can continue to receive their care via telehealth beyond the pandemic.
Implementing clinic to home telehealth services to promote quality of life for ambulatory oncology palliative care patients.
Authors: Begnoche Megan , Guyer Dana , Korber Susan F. , Fenton Mary Anne 
Published: October 2020

259 Background: The Lifespan Cancer Institute (LCI) identified strategies to improve the palliative care experience and outcomes by providing clinic to home telehealth services. LCI is an integrated academic medical center program combining three hospital programs operating at five outpatient sites. One quality goal is to embed and increase palliative care within the fabric of oncology by providing palliative telehealth in the home to avoid office visits, ED and hospital admissions. Methods: LCI’s multidisciplinary palliative care team, including administrators, physicians, advanced practice providers and community partner physicians assessed telehealth challenges with a vulnerable patient in the home setting. Process development included operations, technology, patient and staff education. The group modified existing Lifespan system workflows, clinic to clinic video for behavioral health and clinic to clinic for providers, to create the clinic to home method. This process benchmarked patient and behavioral health noting video differences with the clinic setting versus the home. Results: Outcome metrics include no show rate, chemotherapy within 14 days of death, ED/ICU within 30 days of death, patient and provider experience. Initial data shows no show rates decreased from 10% (January) to 6% (May) as telehealth increased. Patients marked deceased within 3 months of a LCI visit for January (n = 52) and May ( = 61) unfortunately did not have a negative trend for chemotherapy in the last 14 days of life (Jan: 8%, May 15%). ED and ICU visits both had modest decreases from January (ED 50%, ICU 29%) to May (ED 48%, ICU 21%). In anticipation of future Press Ganey results, patient feedback includes an increase of comfort while at home. Provider satisfaction increased with the ability to assess the patient in their own home instead of the sterile clinic environment. Encountered challenges include insurance restrictions for Rhode Island (not a rural state), technology, and remote trouble shooting. Conclusions: The success of clinic-to-home telehealth services set the foundation for the COVID-19 telehealth insurgence and led to the palliative team acting as role models to medical and radiation oncology. End of life oncology patients stayed home while having their palliative needs addressed remotely. The innovative approach to implementing telehealth services will serve as a model for future LCI telehealth programs including treatment education sessions, oral chemotherapy follow-up, survivorship and post hospital discharge assessments.
Active Living After Cancer: Converting a group physical activity intervention for cancer survivors to a virtual format in response to the coronavirus pandemic.
Authors: Basen-Engquist Karen , Liao Yue 
Published: October 2020

261 Background: Active Living After Cancer (ALAC) is an evidence-based group program to help cancer survivors improve their physical functioning and quality of life through increasing physical activity. It has enrolled over 800 cancer survivors in the Houston and El Paso areas. The program prioritizes serving minority and medically underserved survivors and is offered in both English and Spanish. As a result of the coronavirus pandemic we converted the program to a virtual format. Here we report preliminary data on the outcomes of the virtual program. Methods: ALAC teaches cognitive and behavioral skills for increasing physical activity to cancer survivors through 12 group sessions. We converted the group sessions to a virtual format using the Zoom platform. Group attendance was monitored by health educators teaching the program, and participants completed questionnaires and did a 30-sec sit-to-stand test before and after the program to assess outcomes (physical activity, quality of life, physical functioning, program satisfaction). We compared outcomes for the virtual groups to those of previous in-person groups. Results: Five classes with 32 participants were started as in-person groups and converted to virtual. The dropout rate was higher (37.5%) in the virtual groups, compared to in-person groups (23.1%). However, both in-person and virtual group participants showed similar increases in physical activity, physical functioning, physical quality of life, and had high satisfaction (see table). Conclusions: Preliminary data indicate that the virtual format is feasible and produces similar outcomes when compared to the in-person format, although drop-out is higher in the virtual format. Virtual group participants may experience fewer mental health benefits (although this could be due to the stress of the pandemic). Additional analyses will include current participants who are completing all sessions virtually. [Table: see text]
Telemedicine usability for cancer care during the COVID-19 pandemic.
Authors: Miller Christian , Kaltman Rebecca Davidson , Leon Andrea , Gesteira Andrea , Duffy Samuel , Burgess Paula Brooke 
Published: October 2020

265 Background: Healthcare delivery via telemedicine has increased substantially amid COVID-19. The George Washington Cancer Center (GWCC) now provides cancer care services via tele-visits for patients at high risk of morbidity and mortality secondary to COVID-19. This study was performed to assess usability of virtual cancer care delivery for patients and providers across specialties. Methods: Participants included patients and providers surveyed to assess baseline usability after initiating tele-visits. Surveys included demographics, Telehealth Usability Questionnaire (TUQ), and questions on perceived safety and preferences around telemedicine. Subjects also provided open-ended feedback for quality improvement. Results: For patients (n = 105), 96% of surveys sent were completed and analyzed. Most patients were ages 50-59 (22%), 60-69 (25%), 70-79 (25%). Breast cancer (38%) was the most commonly reported cancer type. Median patient TUQ scores were: 5/5 for Interaction Quality (ItQ) and Ease of Use (EU), 4/5 for Usefulness (U), Interface Quality (IfQ) and Satisfaction (S), and 3/5 for Reliability (R). No association was found between TUQ scores and age groups (p = 0.15), sex (p = 0.69), or timing of diagnosis in relation to telemedicine visit (p = 0.67). Compared to in-person visits, 70% of patients agreed/strongly agreed that telemedicine made them feel safer, 63% agreed/strongly agreed that it reduced stress, and 59% expressed interest in using it with other medical specialties. For providers (n = 85), 88% of surveys sent were completed and analyzed. Most providers were ages 30-39 (37%), 50-59 (23%), and 47% had 50 or more experiences with telemedicine. The predominant specialty participating was Internal Medicine (31%). Median provider TUQ scores were 4/5 for ItQ, EU, U, IfQ and S, and 2/5 for R. No association was found between TUQ scores and experience with telemedicine (p = 0.31), though providers aged 60-79 had significantly more negative views of telemedicine (p = 0.02) as compared to other age groups. The majority (97%) agreed/strongly agreed that telemedicine improves access to care, yet 57% expressed concern about missing something they may have caught in person. Conclusions: The use of telemedicine in cancer care was perceived favorably by patients and providers. All patient groups scored highly on perceived safety, reduced stress and improved access, independently of subject characteristics. Providers demonstrated some dissent, particularly in older age groups. These findings provide a useful benchmark for advancement of virtual care delivery in cancer care.