bluuebunny/crossref_metadata_2025_split huggingface dataset:
Integration of pathology within the multidisciplinary cancer care team.
Authors: Plotkin Elana , Allen Timothy Craig , Brown Sandra , Gutman Pablo , Herndon Dana , Nowak Jan A. , Martin Jeremiah , Mohamed Mohamed , Gandee Marianne , Lucas Lorna 
Published: October 2019

49 Background: In an era of precision medicine the role of pathology in the diagnosis/management of cancer is evolving. Pathologists are positioned at the intersection of multiple points along the cancer care continuum. Starting at diagnosis pathologists provide expert interpretation and may recommend biomarker testing to guide treatment decisions. Methods: ACCC joined with partners AMP, ASCP, and CAP administered a survey in June 2018. 659 responses were received from a multidisciplinary group and a variety of cancer program settings. Results: Respondents reported that breakdowns in communication are most likely to occur when selecting and ordering biomarker tests (78%) and when reporting the results of the tests (34%). The top 5 challenges reported were coverage/reimbursement, insufficient quantity of material, turnaround time, test selection/ordering, and communication across the multidisciplinary team. There were sizable gaps in regular ordering of NGS among those with 1 tumor board (28%), 2-3 tumor boards (42%) and 4+ tumor boards (64%). Current use of liquid biopsy remains low with the majority (52%) reporting that clinicians rarely order ctDNA testing (12% “routinely”). Time to receiving test results varied with 58% reporting 5-10 business days, 19% reporting <5 business days and 24% >10 business days. 43% indicated pathologists are authorized to order all types of cancer biomarker tests. 56% have molecular pathologists on staff, 24% have a cancer genetics team. 62% report pathology has access to all inpatient records (38% outpatient records). Conclusions: Programs viewed as having integrated pathology participation feature pathologists leading institutional biomarker testing protocols, active participation at tumor boards and standardized reflexive testing pathways that reduce waste & turnaround time. Full integration is a critical piece to ensure patients receive appropriate and timely care.
Cross training of APPs on inpatient oncology units as a safe and cost-effective model.
Authors: Koniarczyk Heather , Tackitt Helen 
Published: October 2019

56 Background: Oncology Advanced Practice Providers (APPs) have not been optimally trained to care for each other’s sub specialty of patients. In times of high census and/or short staffing, inpatient APPs are left to care for and manage high volumes of acutely ill patients. This is concerning for patient safety, burning out as well as dissatisfactions when vacation and meetings are denied because there is no backup coverage available. Methods: In order to minimize the use of overtime pay, physician moonlighting pay and additional positions in times of short staffing, we proposed to cross train experienced APPs to see if the staffing needs could be met. The disease groups consisted of transplant, leukemia and lymphoma. Each disease group has a lead APP involved in the strategic planning and implementation process. They were instrumental in working through and identifying risks and benefits of this training plan and were the first to be trained, as to lead by example. Buy in from APPs was achieved by promoting the flexibility of scheduling that would result from having more coverage. Some were also motivated to add to their skill set by learning how to care for a new disease group. Results: The APPs felt comfortable taking patients after around 2 training shifts. They felt the patients were more alike than different and the workflow for most job duties were identical, and enjoyed working with fellow oncology APPs they hadn’t interacted much with. Cross training was proposed to add a financial benefit to our institution. Key metrics we monitored were productivity and supplemental pay. The financial savings from avoiding supplemental overtime or fellow moonlighting wages for 2018 was $8,540, and $14,640 for quarter1 2019. The APPs had no decrease in productivity to date, and no decrease in quality metrics and no adverse events related. Conclusions: Cross training as a means to reduce short staffing financial burdens while advancing the scope of practice of APPs is a safe and possible alternative to adding positions, or paying overtime/moonlighting pay. Training of cross covering APPs was not overall a major constraint. Buy-in from leadership as well as APPs is instrumental in not only initiating a cross training program, but maintaining it as well.
Pilot study to assess a pharmacist- and medication navigator-led intervention of oral anticancer medication (OAM) adherence.
Authors: Lin Mingqian , Hackenyos Douglas W. , Parsons Susan K. , Rodday Angie Mae , Murphy-Banks Rachel , Weidner Ruth Ann , Savidge Nicole 
Published: October 2019

58 Background: While advances in OAM make treatment more convenient for patients, OAM must be taken and handled correctly. Studies show gaps in patients’ knowledge of taking/handling OAM, suboptimal adherence, and worse outcomes. A prior study at our institution showed low patient understanding of OAM taking (30%) and handling (15%). Other pharmacist (RPh)- or nurse-led interventions have included patient education, short-term follow-up, and reminder tools. No studies have examined multisession interventions co-led by an RPh and medication navigator (MN). This ongoing pilot study assesses the feasibility of such an intervention, its impact on patients’ understanding and adherence, and patient acceptability. Methods: Patients at our institution met with an RPh and MN for an education and teach-back session at OAM initiation (T1). Patients were given a Drug Information Sheet and Medication Calendar as educational tools. Patients were then invited to enroll in a multisession intervention, including an RPh-led re-education at the first refill (T3) and MN-led boosters (T2, T4). At each session, teach-back responses were recorded and participants completed study measures and evaluations. Preliminary results on T1 and T2 are presented. Results: To date, 37 (95%) patients enrolled at T1 and 33 completed the MN-led booster a week later (T2). At T1 and T2, 85% of participants demonstrated sufficient understanding of OAM taking and handling. However, despite high levels of self-reported adherence, 48% lacked knowledge about when or where to get a refill. At T1 (32%) and T2 (60%), of patients raised issues that were not previously shared with their clinical team. Patients were highly satisfied with the intervention and found the education session, booster, and educational tools useful. Conclusions: While data collection is ongoing, preliminary results suggest this intervention is feasible, enhances patient understanding and adherence to their medications, and is acceptable to patients undergoing OAM treatment. Integration of RPh and MN into oncology teams can enhance care delivery and provide timely assistance for OAM-related issues, providing insight into future models of care.
Implementation of an enhanced recovery program framework in medical oncology.
Authors: Campbell Brittany C , Ong Yvette , Eska Jarrod , Mathai Sharon , Mendez Noel , Olanigan Maroof , Varghese Susy , Waits Mark , George Marina C. 
Published: October 2019

66 Background: Enhanced recovery programs (ERPs) apply multi-modal approaches to manage symptoms, decrease complications, and reduce length of stay (LOS). Widely adopted in surgical settings, there is limited evidence of their implementation in non-surgical patient cohorts. An ERP was implemented in a medical oncology population at a National Cancer Institute-designated comprehensive cancer center. The aim of this quality improvement initiative was to evaluate the implementation of an enhanced recovery framework and determine feasibility in medical oncology. Methods: Enhanced recovery in medical oncology (ERMO) was implemented using Plan, Do, Study, Act methodology. Implementation included introduction of integrative medicine, opioid sparing alternatives, fluid and nutrition management, and functional mobility. Outcome measures included symptom distress as measured by the Edmonton Symptom Assessment Scale (ESAS), return to intended oncologic therapy (RIOT), LOS, and opioid use, evaluated from January 2017 through April 2018. Results: A total of 50 patients were evaluated during the program implementation, and compared with 49 control patients retrospectively reviewed prior to ERMO implementation. Average LOS for ERMO patients was 7.3 days compared to 5.5 days for the control group. Time to RIOT averaged 18.9 days for control patients (n = 30) versus 20.8 days for ERMO patients (n = 17). Nineteen patients (38%) had a reduction in morphine equivalent daily dose (MEDD) from admission to discharge, with an average MEDD of 328.47 milligrams per patient. Conclusions: ERMO as a framework is feasible. The patient reported outcomes such as ESAS and RIOT, and barriers to implementation, including participant engagement and patient pain management perceptions, should be evaluated in the context of larger clinical trials.
Evaluating the early impact of adding a financial counselor to an Oncology Care Model pilot program.
Authors: Liang Margaret , Summerlin Sarah S. , Rocque Gabrielle Betty , Salter Terri , Wiersma Mark , Huh Warner King 
Published: October 2019

67 Background: The Oncology Care Model (OCM) emphasizes the importance of patient costs. Our practice identified a need for patient financial counseling (Plan) and added a financial counselor to the care team (Do). Our objective is to describe the financial counseling process and evaluate (Study) the impact of adding a financial counselor to address financial burden among cancer patients. Methods: New treatment orders trigger a task to the financial counselor who mails a letter including personalized insurance benefit information (i.e., deductible, out of pocket maximum, amount met to date), estimated out of pocket cost for prescribed chemotherapy regimen, and additional financial resources. The health care team can also place referrals for identified needs. Data on patient characteristics, referral patterns, and services delivered was abstracted from the electronic medical record. Results: The financial counselor contacted 157 cancer patients from 4/2018-4/2019, including 134 (85%) OCM patients. The average age was 68 years old (range 22-91); 93 (59%) patients were female; 39 (25%) patients identified as black. Out of 32 patients with documented income, the average annual household income was $25,000. Most patients had Medicare Part D coverage (67/73, 92%) and secondary insurance (59/77, 77%). The financial counselor contacted patients by mail (52/77, 68%), phone (13/77, 17%), in-person at clinic (7/77, 9%), e-mail (1/77, 1%), or using multiple methods (4/77, 5%). Actions taken included mailing insurance benefit and estimated out of pocket cost letters (60/72, 83%), referring to social workers or lay navigators (5/72, 7%), or reviewing insurance benefits (4/72, 6%). Co-pay applications through foundation grants were submitted by the financial counselor for 27 patients of which most (23/27, 85%) were approved. Conclusions: Financial counselors provide diverse services to cancer patients to reduce financial burden, including to patients without secondary insurance who were noted to have additional financial needs. Patient satisfaction surveys and accounting for the dollar amount returned to patients and the health system represent next steps for our new program (Act).
"Cancer Life ReiMagined:" The CaLM model of whole-person cancer care.
Authors: Schear Rebekkah , Eckhardt S. Gail , Kvale Elizabeth Ann , Richardson Robin , Jones Barbara L. 
Published: October 2019

74 Background: Despite advances in cancer treatment, the orientation of our health system does not address the whole cancer patient or support the wellbeing of the heart, soul, and mind. We launched the CaLM Model of Whole Person Cancer Care, an oncology medical home approach that integrates high acuity, sub-specialty clinical cancer care with comprehensive, ongoing supportive care. The CaLM Model operationalizes the six components in the conceptual framework set forth in the NASEM’s 2013 report. Delivering High-Quality Cancer Care. Methods: Beginning December 2018, we piloted a “flipped” ambulatory care model in GYN and GI oncology delivering daily care through a subset of providers, the SWAT Team: a palliative NP, med onc NP, clinical social worker, and navigator. The SWAT Team triages all physical and social needs. As opposed to anchoring care with the oncologist and referring the patient out to social services, the SWAT team anchors care and the oncologist plugs in for treatment planning. The CaLM Model also utilizes coordinated, interdisciplinary care including financial and fertility navigation, nutrition, genetic counseling, pharmacy, and psychiatry, to manage the patient’s needs via a team-based approach by assessing and addressing the patient’s needs according to their values and preferences. We designed a new clinical and psychosocial assessment tool and patient-facing care plan; launched a Multi-Disciplinary “whole-person” case review process with all interdisciplinary providers and measured patient reported outcomes using the FACT-G, PHQ, GAD, and MD Anderson Symptom Inventory at baseline (initial visit) and every clinical visit. Measured at initial visit and every 6 months. Results: Early data show that the CaLM Model reduces patient symptom burden while improving quality of life. Conclusions: The CaLM Model is an efficient use of resources, compared to a traditional oncologist-focused model of cancer care. Further research is underway to assess cost benefit to the system, the patient and the payers. Ultimately, the CaLM Model may shift the paradigm of cancer care by demonstrating the feasibility and effectiveness of a patient-centered model of care delivery that builds a foundation for a value-based payment model.
Optimization of inpatient chemotherapy administration utilizing evaluation intervals.
Authors: Ramanathan Sabarina , Yenamandra Avani , Vuppala Aparna , Shan Khine , Lara-Martinez Hugo R. , Khan Rabia , Hanson Shaun Bryan , Safa Ahmed , McCormack Michael Joseph , Ward Kristine Marie , Styler Michael 
Published: October 2019

75 Background: Inpatient chemotherapy requires an interdisciplinary approach to achieve shorter hospital stays and decrease cost. A quality improvement project at Hahnemann University Hospital was undertaken to identify delays in the process from admission to chemotherapy initiation in this population. Methods: Time stamps were recorded for patient arrival (door to floor), order placement (floor to order), and administration (order to chemo) to establish a baseline. A multidisciplinary team of pharmacy, nursing, and physicians was developed to address inefficiencies. There were three evaluation intervals: May - October 2015 (Part I), January 2017 - October 2018 (Part II) and October - December 2018 (Part III). Data collected from Part I established a baseline door-to-chemo time (DTC) of 7.2 hrs. Post Part I, prompt communication of patient arrival and delays in chemotherapy hanging were addressed. Part II interventions were outpatient consents and labs, timely order placement, and utilization of order sets. Pharmacy-nurse communication and equal distribution of patients through the week was implemented in Part III. The primary outcome measure was difference in DTC. Results: 200 admissions were reviewed. Results of the evaluation intervals are shown in Table. After the first evaluation interval, DTC improved from 7.18 to 5.96 hrs. DTC further decreased to 5.78 hrs post intervention II. The longest delay was between chemotherapy order and administration. Conclusions: DTC significantly improved between intervals with the above interventions. Utilizing a standardized nursing checklist and biweekly multidisciplinary meetings to emphasize prioritization will further decrease DTC. DTC reduction will decrease cost and increase patient satisfaction. [Table: see text]
Implementation of standardized workflows to reduce inpatient length of stay for medical oncology patients.
Authors: Hooley Joseph , Koniarczyk Heather , Carrino Cheryl M. , Primm Kimberly , Westrick Curt , Brusio Michelle , Cummings Chad W. 
Published: October 2019

80 Background: Reducing length of stay (LOS) is an important initiative for hospitals for both clinical and financial reasons. Patients who are hospitalized for extended lengths of time may be more susceptible to hospital-acquired infections and other complications. Reducing LOS can also decrease cost of care and allow for more streamlined patient throughput. Our institution sought to evaluate opportunities to reduce LOS for our medical oncology patient population. Methods: Several interventions were implemented to streamline discharge planning. The structure of rounding was evaluated and standardized on each inpatient oncology unit to ensure that it was multidisciplinary and occurred each day at an established time. A process was established for Advanced Practice Providers (APPs) to write prescriptions the day before discharge (delivered directly to the bedside), and for APPs to begin discharge of patients early the following morning with use of a new discharge checklist. Standardized workflow was also created for instances where prior authorizations were required for prescriptions. We partnered with our Home Care providers to streamline the process for patients anticipated to be discharged to that service. Partnership was also established with physical therapy (PT) to avoid ordering low-value consults and to provide enhanced education to nursing staff about early patient mobility. Another project is being piloted to move lab draws six hours earlier the night prior to discharge. This provides the medical team additional time to assess and treat based on lab results if the patient required blood product transfusions or electrolyte replacement prior to discharge. Results: Implementation of interventions began throughout the first several months of 2019. Each of the first four months of 2019 saw consecutive improvements in both observed average LOS and LOS observed-to-expected ratios. Overall, a 2% decrease was seen in both of these metrics when comparing January to April 2019 to the 2018 baseline. Conclusions: Implementing several interventions to streamline workflows and processes leading up to a patient’s discharge can be effective in reducing both overall LOS and LOS observed-to-expected ratios.
The Oncology Evaluation Center: Implementation of a same-day evaluation and treatment center to avoid unnecessary ED visits.
Authors: Zinck Lindsey , McGettigan Suzanne , Braun Jennifer , Walsh Abbey , Cullen Lauren 
Published: October 2019

81 Background: Oncology patients have high rates of both Emergency Department (ED) visits and readmissions. The Hematology-Oncology Division at this urban, 776-bed academic medical center established the Oncology Evaluation Center (OEC) to provide cancer patients with prompt ambulatory evaluation for new symptoms that may otherwise lead to ED visits and unplanned admissions. With new therapeutic options associated with unique complications, the OEC Advanced Practice Providers are knowledgeable in providing care to this high-risk population. ED providers can lack oncology-specific training, comfort, and confidence when caring for cancer patients, resulting in sub-optimal care. Methods: A retrospective review of the chief complaints (CC) of oncology patients presenting to the ED was conducted. Using Plan Do Study Act methodology, in 2016 the OEC was opened to provide same day evaluations and interventions to patients with symptoms related to their cancer diagnosis, their treatment, or their comorbidities. Inclusion and exclusion criteria were developed to ensure appropriate referrals to the OEC. A hospital awareness campaign launched to promote OEC referrals, including educational sessions at multidisciplinary tumor boards. Additionally, two Lean Six Sigma trained infusion RNs led initiatives to promote OEC utilization. Results: The OEC resulted in quick evaluation and intervention for oncology patients. The most common CC are pain, dehydration, fever, nausea/vomiting, and fatigue. Of the 2721 patients seen to date in the OEC, 72% were discharged to home. According to survey results, 81% of oncology providers agree that if the OEC were not in existence, patients referred to the OEC would be referred to the ED. Oncology readmission rates have decreased from 14% (2016) to 12% (2018). Conclusions: The OEC has proven to be an innovative solution for prompt evaluation and ambulatory treatment of cancer patients with complications. This is a valuable component of comprehensive patient-focused care, resulting in ED visit and readmission avoidance. The OEC is an effective low cost, high reward programmatic strategy to expand access to care while improving patient experience.
Pharmacy involvement in an oral anticancer management program: Drug acquisition and safety in an ambulatory comprehensive care center.
Authors: Szabatura Audrea H , Kaymakcalan Marina D. , Cao Cathy , Nguyen Phuong 
Published: October 2019

85 Background: Oral anticancer agents (OACA) offer benefits of convenience, flexibility and quality of life; however, similar to intravenous therapy, OACA can be prone to medication ordering errors, drug-interactions, and administration errors. Additionally, they carry unique challenges such as treatment delay due to acquisition barriers and errors related to self-administration and monitoring. An oral anticancer management program was implemented to address vulnerable aspects of the outpatient OACA medication use process. Pharmacy benefit specialists (PBS) assist with prior authorizations (PA) and drug acquisitions; while, clinical pharmacists perform medication assessments and patient education. Methods: A retrospective review of patients prescribed OACAs between January 1 - March 31, 2019 was performed. A review of all PAs facilitated by our PBS was conducted and included date of prescription, date of submission to insurance, and date of PA approval. An assessment of pharmacist interventions on the prevention of medication-related errors and toxicity was conducted and was defined by any clarification or recommendation regarding medication dose, administration instructions, drug interactions, symptom management, medication reconciliation, and/or medication monitoring. Results: A total of 567 PAs were processed. Twenty-eight PA requests were denied and 539 were approved. The average time to approval was 1.5 days (range 0-13 days). 299 of the 567 patients were prescribed a new OACA and were enrolled into our education program. Pharmacists educated 191 patients. Pharmacists intervened 175 times for the 191 patients counseled. Interventions included recommendations/clarifications for symptom management (21.5%), medication reconciliation (19.5%), drug administration (16.2%), drug interactions (13.6%), and medication monitoring (7.3%). Conclusions: Pharmacy staff can make a valuable contribution to drug acquisition and overall clinical care of patients receiving OACAs. Our PBS reduced delays in acquisition and clinical pharmacists minimized medication-related errors and toxicity.