bluuebunny/crossref_metadata_2025_split huggingface dataset:
Achieving best possible cancer treatment outcomes in care pathways through benchmarking: ABC benchmarking.
Authors: Wind Anke , Bessems Maud , van Eekeren Ramon RJP , Wijburg Carl J , Wijn Rob P.W.F. , Mattson Johanna , Borges Marina , Abreu de Sousa Joaquim , Oliveira Jorge , Halamkova Jana , Svoboda Marek , van Harten Wim H 
Published: October 2019

268 Background: Care pathways are used to manage quality in healthcare and concern the organization and standardization of care processes. By benchmarking care pathways, new knowledge is generated that can be utilized to optimize care pathways. A recent development in healthcare is the transformation from volume-based healthcare to value-based healthcare, which amongst others emphasizes the need for IPU (Integrated Practice Unit) development. The ABC-Benchmarking project is an international benchmarking project aiming to further develop the BENCH-CAN pathway benchmark, establish comparative scores on IPU development, and link outcome data to benchmark results. Methods: The 13 step benchmarking process as developed by Van Lent et al. was used. Indicators were primarily derived from the BENCH-CAN pathway benchmark format and secondary from expert opinion. An adapted Delphi method, in which clinical experts on breast and prostate cancer provided feedback in three rounds, was used to select the final set of indicators. The indicator sets containing structure, process and outcome indicators were piloted in 5 centers. Clinical outcome indicators were collected primarily through cancer registries. Site visits were performed to clarify additional questions based on the provided data and to grasp the context of the care pathway. Results: The final set contained 79 indicators for breast and 69 indicators for prostate cancer. Due to differences in registration and data availability of cancer registries not all data could be collected for all centers. Differences between cancer centers were found for example in the measurement of patient reported outcomes and status of the IPU. Aggregated and comparative data can be shown during the symposium. Conclusions: Further validating the pathway benchmark tool and adding more focus to IPU development and outcome indicators led to new knowledge on adding value for cancer patients. Examples given were optimizing care organized in care pathways for breast and prostate cancer patients. The results provided improvement opportunities for all centers. A study into patient involvement in pathway development, evaluation and improvement is also part of this project.
Treatment patterns and barriers involving the use of CDK4/6 inhibitors for women with HR+, HER2- breast cancer.
Authors: Tolaney Sara M. , O'Shaughnessy Joyce , Ackbarali Tariqa , Crawford Rebecca , Carter Jeffrey D. , Greene Laurence , Sapir Tamar 
Published: October 2019

27 Background: For women with HR+, HER2- breast cancer, cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) can significantly improve outcomes. However, the most effective uses of CDK4/6i may be limited by barriers including a lack of systems-based pathways and education to guide individualized treatment. In a quality improvement program in 2 healthcare systems, we assessed baseline treatment patterns and barriers involving CDK4/6i use. Methods: Participants were 34 oncologists and team members. At baseline, we administered surveys to assess barriers to prescribing CDK4/6i and audited the EMRs of 100 women with HR+, HER2- breast cancer in each system. EMRs were audited for demographics; disease characteristics; and treatment history, monitoring, and shared decision-making (SDM) involving CDK4/6i. The teams participated in an audit-feedback session and developed action plans for resolving gaps. Results: Overall, 31% of the 200 women received a CDK4/6i, and 13% received a CDK4/6i as second-line therapy. More than 30% of women treated with a CDK4/6i had documentation of only Stage I/II disease. EMR audits revealed low rates of recommended electrolyte monitoring and ECGs (0%), liver function tests (LFT; 44%), and SDM (Table). Surveys were completed by 20 participants. Whereas 80% indicated being likely to recommend a CDK4/6i, they reported barriers of identifying eligible patients (35%) and monitoring for disease progression (45%). A moderate proportion of oncologists reported considering menopausal status (60%) and patient preferences (50%) in CDK4/6i decision-making. Participants developed action plans for improving EMR documentation for disease stage and protocols for monitoring progression. Conclusions: These baseline findings reveal gaps that may inform QI initiatives for promoting the appropriate use of CDK4/6i for women with HR+, HER2- breast cancer. Findings from baseline EMR audits (n = 200). [Table: see text]
Hospitalization rates related to coordinated home healthcare services with a community oncology practice.
Authors: Sandbach John F. , Bachelor John , Larson Kimberly , Jordan Denize , Mullins Janet , Sheff Gregory 
Published: October 2019

273 Background: Unplanned hospital admissions or hospital re-admissions in cancer patients after discharge cost in excess of 16 billion dollars. Oncology patients are a very high risk of hospitalization despite the involvement of a home healthcare agency. The 30-day medical oncology re-hospitalization rates are reported to be 21.6%. Unplanned hospitalization rates in selected oncology patients over a 12 month period have been reported to be as high as 58%. Methods: A large home health agency and a community based medical oncology practice created a delivery model referred to as the Advanced Community Care Model (ACCM). We are reporting our initial 14 month experience. The initial pilot involved three of the medical group’s six cancer centers. The ACCM created standing intervention orders regarding hydration, nausea/vomiting, central line management, antiemetic and diarrhea and a continuum of monthly management meetings with the agency and the practice. Navigation services by a designated RN were provided. Enhanced interventions with either telephone communication or home visits took place when deemed appropriate. Results: ACCM impacted 60-day hospitalization rates fell a baseline at 6 months into the program from 43% to 22% by the end of the 18 month pilot. Avoidable hospitalizations and re-hospitalizations related to N/V, pain, SOB and infection were less than 10%. The initial program has involved 310 unique patients. Conclusions: The reduction in the 60 day hospitalization rates and the low hospitalization and re-hospitalization rates related to pain control, infection, SOB and infection were below published national averages. The results were felt to be encouraging and the ACCM will be expanded to involve all 7 cancer centers in the practice.
Impact of community practice on providing in-patient oncology and hematology consults via telemedicine to remote rural hospital.
Authors: Dickson Natalie R. , Bilbrey Larry Edward , Joseph Mathew John , Matheny Janet A , Poole Stacey L , Patton Jeffrey 
Published: October 2019

278 Background: A rural oncology/hematology clinic located a far distance from the local community hospital was not able to provide hospital consultation support. Collaboration between the practice and the hospital resulted in a telemedicine pilot study to provide oncology and hematology consults to in-patients using a telemedicine robot that connected patients to a hematologist/oncologist (heme/onc) over the internet. Methods: When an appropriate patient was identified at the hospital, a referring provider contacted the heme/onc for a consult. The heme/onc determined and relayed the appropriate time to schedule and perform the telemedicine consult. The referring provider arranged for hospital staff to deliver the telemedicine robot to the patient’s room at the scheduled time. The heme/onc reviewed clinical data in the hospital EMR and logged into the telemedicine robot to speak in consultation with the patient. Notes and orders were placed in the EMR. Out-patient follow-up at the oncology/hematology clinic was scheduled as needed. Supporting front-office and clinical workflows were developed, and policy and procedure established. Surveys were sent to patients and referring providers. Results: At baseline, hospital consults were not provided. In 2018, there were 27 oncology/hematology consults, of which 89% (24 of 27) were for malignancies. 52% (14 of 27) were seen in the clinic after discharge. To date 40 telemedicine consults have been completed. Patient and referring physician satisfaction are inconclusive due to low survey return. Conclusions: Telemedicine provides an effective means to provide specialty consultative support to rural hospitals by remote community providers. Despite the complexity and sensitive nature of oncology and hematology concerns, the technology has been embraced by referring providers and patients.
The effect of medical home enrollment on cardiometabolic medication adherence among Medicaid-insured cancer patients.
Authors: Spees Lisa , Wheeler Stephanie B. , Zhou Xi , Amin Krutika B , Baggett Chris , Lund Jennifer Leigh , Urick Ben , Farley Joel , Reeder-Hayes Katherine Elizabeth , Trogdon Justin G 
Published: October 2019

279 Background: Medical homes, developed to increase care coordination among vulnerable patient populations, have been successful in improving outcomes of patients with multiple chronic comorbidities, but have not been evaluated among cancer survivors. We determined the impact of medical home enrollment on adherence to anti-diabetics, anti-lipidemics, and anti-hypertensives among Medicaid patients diagnosed with non-metastatic breast, colorectal, or lung cancer. Methods: Using linked cancer registry and claims data from North Carolina, we included Medicaid-insured adults diagnosed from 2004-2012 with breast, colorectal, or lung cancer who had at least one cardiometabolic condition (i.e., hyperlipidemia, hypertension, and diabetes mellitus). For each cardiometabolic condition, we measured medication adherence using ambulatory proportion of days covered (PDC). We examined the impact of medical home enrollment on PDC across the phases of cancer care (i.e., pre-cancer diagnosis, treatment, and survivorship phases) using a differences-in-differences model. All models adjusted for age, sex, race/ethnicity, dual enrollment, cancer type, comorbidity index, and number of cardiometabolic conditions. Results: We included, respectively, 765, 1079, and 1634 cancer patients with diabetes, hyperlipidemia, and hypertension. Overall, adherence to anti-lipidemics was lower than adherence to anti-diabetics and anti-hypertensives. In the pre-diagnosis phase, mean PDC across all cardiometabolic conditions was slightly lower for cancer patients enrolled in a medical home than those not enrolled in a medical home. However, medication adherence improved 3-5% in the treatment phase and 7% in the survivorship phase for cancer patients in a medical home compared to cancer patients not in a medical home during the pre-diagnosis phase. Conclusions: These results provide evidence that enrollment in a medical home can improve medication adherence, even among vulnerable cancer patients with complex health needs. The medical home model is an effective healthcare system intervention through which to provide better care coordination and improve patient outcomes.
Mixed-methods research to evaluate a novel patient-centered cancer care coordination instrument.
Authors: Okado Izumi , Cassel Kevin , Pagano Ian , Holcombe Randall F. 
Published: October 2019

280 Background: Effective care coordination (CC) is a critical component of high-quality cancer care; however, efforts to improve cancer care coordination are hampered by limited patient-centered measures. This mixed-methods research reports on patients’ feedback and the utility of a novel care coordination instrument (CCI) designed to assess cancer care coordination. Methods: 7 focus group discussions were conducted with 68 cancer patients receiving active therapy to evaluate validity of the CCI. Subsequently, the CCI was modified and administered to additional 200 cancer patients derived from community-based private and hospital clinics. The CCI is a 29-item, multiple-choice questionnaire and includes subscales that evaluate CC in 3 domains (Communication, Navigation, Operational) across 4 areas of CC (patient-physician; between providers; during inpatient-to-ambulatory care transitions; during transitions across phases of care). Results: Qualitative analysis of focus group discussions demonstrated that the CCI has good face and content validity. Content analysis identified the following themes: Survey, Education/Knowledge, Navigator, Communication, Support, Access, Providers, and Team. Questions with unclear wording or high proportions of not applicable or missing responses were refined or removed. Results of the revised survey indicated that the CCI is able to distinguish patient- and practice characteristics associated with optimal/poor CC. Specifically, cancer types (leukemia, myeloma) and having a patient navigator predicted high overall patients’ ratings of CC ( p < .05). Marginally significant differences were found for practice setting ( p = .085). A multiple regression model with all predictors entered simultaneously revealed that the presence of a family/friend caregiver significantly predicted better CC ( p < .001); however, the benefits of a patient navigator were no longer significant. Conclusions: This study demonstrates the utility of the CCI for assessing patients’ perspectives of cancer CC. Use and integration of this instrument in oncology practices/clinics can identify areas of potential interventions for CC improvement and lead to a better quality of care.
Quality improvement of lung cancer patient selection using clinic-based spirometry.
Authors: Lam Tony Kin- Ming CL , Aggarwal Reenika , Stewart Erin L. , Hueniken Katrina , McGregor Maureen , Xu Wei , Schmidt Heidi , Kavanagh John , Liu Geoffrey 
Published: October 2019

282 Background: Coordinating lung cancer screening requires risk assessment for patient selection. Optimal selection can reduce costs and improve efficiency of low dose computed tomography (LDCT) screening of lung cancer. This study evaluated clinic-based spirometry as a tool to improve patient selection for lung cancer screening. Methods: Eligibility criteria for three large LDCT screening studies were retrospectively applied to the highest risk patients enrolled in the Princess Margaret Lung Cancer Screening Program who had received clinic-based research spirometry. The three studies were: Danish Lung Cancer Screening Trial (DLST), National Lung Screening Trial (NLST), and the Ontario Lung Cancer Screening Program (OLCS). Lung cancer incidence was compared between those who would were included by the screening study eligibility criteria (Group I), those who were excluded by the eligibility criteria but demonstrated obstruction on spirometry (defined as a Forced Expiratory Volume in 1 Second % Predicted (FEV1%) < 90%) (Group II), and those who did not meet eligibility criteria and had no obstruction (FEV1% ≥90) (Group III). Results: The 321 highest risk participants of the screening program had a mean age of 65 years and were 39% male. The median number of pack years in this group was 39. After undergoing spirometry, this cohort was screened using LDCT for a median of 3.3 years (range 1–8.1 years). Under DLST criteria, Groups I and II had virtually identical lung cancer incidences detected by screening at 13.1% and 13.6% of the individuals screened, respectively; Group III had a substantially lower incidence at 6.3%. Results were similar by NLST criteria where the incidence of screen-detected lung cancer were 13.7% for Groups I, 11.1% for Group II, and 8.6% for Group III. Under OLCS criteria, these values were 13.4% (Group I), 13.5% (Group II), and 8.2% (Group III). Conclusions: Individuals who were excluded from LDCT screening because they lacked other clinical eligibility criteria, but had a FEV1 < 90%, had similar lung cancer incidence as patients who had met screening study eligibility criteria. Coordinating care for screening of at-risk individuals could be improved by incorporating spirometric tools.
Utilizing technology for malnutrition screening and referrals to nutrition services.
Authors: Franco Susan , Hanson Corrine , Woscyna Glenda , Wells Jana , McLarney Meghan 
Published: October 2019

284 Background: The incidence of disease-related malnutrition in oncology patients ranges from 40-80%. This is the highest of all hospital patient groups. Malnutrition is associated with decreased quality of life, increased healthcare costs and intolerance to treatment. Screening for nutrition risk is often lacking in outpatient settings. Electronic health records could be utilized to improve the delivery of validated nutrition screening tools such as the Malnutrition Screening Tool (MST) in outpatient oncology settings. Methods: We designed a pilot project (Feb-July 2018) to administer the MST for outpatient oncology patients seen at the Fred and Pamela Buffett Cancer Center (FPBCC) using an electronic medical record system. “Best Practice Alerts” (BPAs) were used to notify the nursing staff of a patient with a screen that was positive for nutrition risk (MST score ≥3). The BPA recommended a referral to nutrition services; nursing staff could choose to “order” or “do not order" a Nutrition Consult. Results: A total of 2,672 patients received MST screening during the pilot. Out of these, 223 (8%) had a positive screen for nutrition risk; 197 of these were eligible for a nutrition services referral. A BPA “fired” 152 times out of 197 eligible patients (77%). Of the197 eligible patients, 58 (29%) were actually referred to nutrition services. Of these 58 referrals, 43 (74%) were triggered based on a BPA, while the remaining referrals were received outside of a BPA. BPAs failed to fire 45/197 times (23%). Conclusions: An EHR-based nutrition screening system to increase referrals in patients identified at nutrition risk in an outpatient oncology setting was effective for 29% of eligible patients. Barriers encountered included failures in technology as well as human factors. During the pilot it was discovered that the BPA was firing in a location in the chart where the nurse did not regularly work. There was not a consistent message as to the goals and outcomes during the pilot which resulted in lack of awareness by nurses to respond to the nutrition risk score. Utilizing an EHR-based nutrition screening tool is an effective way to identify patients at risk and refer them to appropriate resources in a timely and efficient way.
Tailoring implementation for a cancer self-management support intervention for patients starting chemotherapy.
Authors: Kirkby Ryan Lawrence , Howell Doris , Powis Melanie Lynn , Amernic Heidi , Moody Lesley , O'Brien Mary Ann , Rask Sara , Krzyzanowska Monika K. 
Published: October 2019

287 Background: Multiple implementation strategies are described in the literature; however, there is limited consensus on how to best tailor implementation to organizational and clinician readiness. We undertook a mixed-methods evaluation to inform tailored implementation of self-management support (SMS) in ambulatory cancer care as the first phase of a pilot randomized trial of the intervention in patients starting chemotherapy. Methods: Validated surveys, focus groups and interviews were undertaken with key stakeholders (oncologists, nurses, allied health, and administrative leaders) in the lung, colorectal and lymphoma disease site groups at 3 regional cancer centres in Ontario, Canada. Median responses to individual survey questions were classified as an enabler, barrier or neutral based on predetermined cut-offs. Enablers and barriers were triangulated with qualitative data and mapped to the Consolidated Framework for Implementation Research domains. Implementation strategies to address barriers were identified using the Expert Recommendations for Implementing Change tool. Results: Survey respondents represented all stakeholder groups (n = 78; respondent rate = 50%). Minimal variation was noted across stakeholders and centres. Overall, respondents held positive beliefs about the value of SMS, were familiar with the principles of SMS and felt there was a tangible fit among the intervention, individual beliefs, and existing workflows. Suboptimal communication networks and access to information about the adoption of SMS, as well as a lack of organizational commitment to implementing the intervention were identified as key implementation barriers. Qualitative data reinforced quantitative findings, namely that stakeholders value SMS but were unsure if it would translate into reduced treatment toxicities. 46 implementation strategies were identified based on perceived barriers, of which 28 (61%) were common to all 3 centres. Conclusions: Stakeholders at cancer centres acknowledged that SMS is valuable, but potential barriers to integration of SMS into routine ambulatory practice exist. The impact of the tailored implementation plans will be evaluated as part of the trial.
Association between Charlson-Deyo Score and delay to colonoscopy in veterans subsequently diagnosed with colorectal cancer.
Authors: Khuc Thi , Jackson Christian 
Published: October 2019

288 Background: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy is associated with increased risk of CRC. The Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The effects of an aging population, physician shortage, and increased military personnel entering the VAHS may increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. Methods: We retrospectively reviewed records of 600 patients referred for colonoscopy from January 1999 to January 2009, who were subsequently diagnosed with CRC. Patients with a prior CRC diagnosis were excluded. The final study cohort consisted of 530 patients. We analyzed the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Logistic regression analysis adjusted for age, race, CRC location and C/D score. Results: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥ 2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, p = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, p = 0.47, OR = 1.37, p = 0.48). Conclusions: Patients with a C/D score ≥ 2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.