bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expert consensus on the development of quality care measures for kidney cancer in Spain.
Authors: Guillem Vicente , Camps Carlos , Climent Duran Miguel Angel , Gonzalez del Alba Aránzazu , Lázaro Quintela Martín Emilio , Mendez Vidal María José , Pinto Alvaro , Puente Javier , Caballero Fernando , Campos Francisco J , Duran Ignacio , Gallardo Diaz Enrique 
Published: May 2020

e19180 Background: To promote the continuous improvement of kidney cancer healthcare by proposing quality care measures (with respective indicators and standards) for its diagnosis, treatment and follow-up care that can be used by the corresponding professionals and that can be applied across the Spanish healthcare system. Methods: 1. a) Bibliographic review of international research (previous 5 years) on the quality of kidney cancer care; b) Multidisciplinary nominal group (9 oncology experts from the ECO Foundation –Excellence and Quality in Oncology Foundation – and 2 university methodologists – Francisco de Vitoria University Faculty of Medicine) to identify and select possible quality measures that can be applied in Spain; c) Modified Delphi Consensus (two rounds, remotely) by a panel of 55 oncologists subspecialized in kidney cancer, selected by a geographically stratified snowball sample. The ASCO (American Society of Clinical Oncology) /QOPI (Quality Oncology Practice Initiative) model is followed for the drafting of each item: definition of measures, indicators, information sources, exclusions, clarifications, categorization, acceptable standards. Results: The nominal group proposed 43 possible quality measures to the Delphi panel. Consensus participation rate = 84.5% (47 specialists). A unanimous consensus was achieved for 40 quality measures, grouped into the following areas: 4 structural, 33 regarding treatment process and 3 regarding clinical results. Conclusions: The level of consensus among Spanish oncologists subspecialized in kidney cancer on the proposed care measure for the management of said cancer is very high (93%). These results indicate widespread acceptance and applicability of said measures in the Spanish National Healthcare System and, with this in mind, they will henceforth be a valuable tool for the comparative evaluation of the quality and fairness of the oncological care of kidney cancer patients in Spain.
Review of annual compliance of low-dose CT for lung cancer screening among internal medicine resident physicians in a university teaching program.
Authors: Lopetegui-Lia Nerea , Drekolias Dimitrios , Jafri Syed Imran Mustafa , Vredenburgh James 
Published: May 2020

e19187 Background: Lung cancer remains the leading cause of morbidity and mortality, with an estimated 2.1 million newly diagnosed cases each year. A large percentage of cases are detected at an advanced stage, making treatment recalcitrant. Only about 15% are diagnosed at an early stage, highlighting the significance of timely screening. USPSTF recommends annual screening with low-dose computed tomography (LDCT) in adults aged 55-80, who have a 30 pack-year smoking history and are current smokers, or former smokers who have quit within the last 15 years. The National Comprehensive Cancer Network (NCCN) guidelines, as well as the National Lung Screening Trial (NLST), recommend annual screening with LDCT until a person is no longer a candidate for definitive treatment. This study aimed to evaluate the compliance with annual LDCT based on USPSTF guidelines among internal medicine residents from the University of Connecticut residency program at a Clinic in Hartford, Connecticut, USA. Methods: Patients who were under the care of internal medicine residents and who had undergone an initial LDCT for lung cancer screening were included. A total of 61 medical charts were reviewed. Three patients were diagnosed with lung cancer and nineteen patients had their initial LDCT in 2019, and therefore excluded. Results: Out of the 39 patients, 10 patients (25.64%) had a follow-up annual LDCT performed, 2 patients before the annual mark due to various clinical concerns, and 9 patients (23%) in the following 24-48 months. 6 patients (15.38%) had a repeat LDCT ordered but was not done or it was canceled. 12 patients (30.77%) had no repeat LDCT ordered at 12 months. Overall, 69.23% had no follow-up CT at 12 months, and 46.15% with no follow up CT at all at the time of chart review. Conclusions: Based on our analysis, follow-up annual LDCT scans for lung cancer screening on patients under the care of residents-in-training are not being ordered frequently enough. The failure to order annual LDCT could be due to a false sense of relief with a normal initial LDCT, the lack of provider’s awareness of USPSTF guidelines, or insurance issues. Educating primary care providers on the importance of follow-up annual LDCT will ensure early detection and decrease mortality from lung cancer in high risk patient population.
Measuring team effectiveness in healthcare: A comprehensive and practical tool.
Authors: Zajac Stephanie , Griggs Andrew , Cavanaugh Katelyn , Lazzara Elizabeth Hunter , Holladay Courtney 
Published: May 2020

e19188 Background: Publication trends reveal that research on teams and teamwork in healthcare has surged over the past decade. Efforts to improve team effectiveness have also become pervasive, with team training being identified as a top strategy for improving patient outcomes. Unfortunately, measures of team effectiveness in the literature vary greatly and are aimed largely toward clinical teams. The aim of this effort, therefore, is twofold: (1) to provide a tool that can be adapted and used to diagnose performance and guide targeted team training across team types, and (2) to further our understanding of teams across all areas of a healthcare system (clinical, research, and administrative) by providing a standard measurement tool. Methods: We began with a comprehensive framework of team effectiveness developed through a top down (i.e., literature review) and bottom-up (i.e., focus groups, interviews) approach. The framework includes 23 constructs identified as critical to teams (e.g., clear roles, supportive culture, conflict management, shared mental models). Next, three subject matter experts (SMEs) identified and compiled measures of team effectiveness published in the healthcare teams literature. Items were reworded as needed to be generally applicable across healthcare team types. The three SMEs then matched each revised item to the framework by independently labeling each with the framework construct it best represents. Items on which 2 out of 3 experts agreed were kept, and new items were generated as needed for construct coverage resulting in a refined item bank. This item bank was again independently rated on quality of item (e.g., clarity, avoidance of double-barreled questions) and construct representativeness (i.e., ensuring the most important aspects of each construct were captured). Two additional subject matter experts then reviewed the ratings, and kept the top five rated items for each construct, ensuring full coverage of the construct (i.e., removing items that were duplicative and tapped the same part of a construct). Results: The processes above resulted in a measure with 115 items that capture 23 fundamental constructs for teams in healthcare. Conclusions: The measure developed is applicable across team types. It can be adapted and used to diagnose team performance, inform training, and further understanding of what facilitates effective teamwork in multi-team systems performing diverse functions across the healthcare system.
Developing a performance matrix for multidisciplinary teams.
Authors: Evans Lynleigh , Liu Yiren , Kwan Terence , Callister James , Byth Karen , Poon Simon , Harnett Paul R. 
Published: May 2020

e19200 Background: While multidisciplinary teams (MDTs) are considered the “gold standard” of care for cancer patients, their performance varies widely. This study aimed to develop a user friendly, reliable and valid self-assessment tool for MDTs to evaluate their performance and monitor improvement over time. Methods: Using maturity modelling methodology, key themes from the literature were developed into a 2-dimensional matrix comprising 17 indicators (within 6 components) across 5 levels of performance. A modified Delphi methodology (where 38 MDT members each assigned the contents to components and performance levels using card sorting software) was used to establish face and content validity. A 10 minute on-line version of the matrix was piloted across 11 MDTs. Each participant estimated where they thought the MDT performed for each indicator. Correlation and factor analyses examining convergent and discriminant validity were conducted using SPSS. Cronbach alpha was used to measure internal consistency and evaluate reliability. Ease of use and usefulness were also examined. Results: A total of 109 members completed the matrix, with representation from medical, nursing and allied health professionals. The mean results for each indicator are shown below (maximum 5). Overall results for the different teams varied from 1.2 to 4.2, with standard deviations ranging from 0.4 to 0.8. Conclusions: This matrix has the potential to be a simple, valid and reliable tool for MDTs to measure their performance and monitor improvement over time. The tool will now be refined and then disseminated to a wider audience for further validation and feedback. [Table: see text]
Enrollment barriers of adolescents and young adults (AYA) on the non-chemotherapy arm of ARST1321.
Authors: Kopp Lisa M. , Reed Damon R. , Ahmed Safia K. , Allen-Rhoades Wendy , Avutu Viswatej , Chen Yen-Lin , Davis Lara E. , Eaton Bree Ruppert , Hawkins Douglas S. , Indelicato Daniel J. , Patel Shreyaskumar , Randall R. Lor , Reinke Denise K. , Riedel Richard F. , Scharschmidt Thomas , Thornton Katherine Anne , Wang Dian , Janeway Katherine A. , Weiss Aaron R. 
Published: May 2020

e19214 Background: ARST1321(PAZNTIS): A Phase II/III Randomized Trial of Preoperative Chemoradiation or Preoperative Radiation Plus or Minus Pazopanib (NCT02180867) was the first National Clinical Trials Network (NCTN) study co-developed by pediatric (COG) and adult (NRG Oncology) consortia anticipating enrollment of adolescent and young adult (AYA) cancer patients. ARST1321 had two treatment cohorts, enrolling patients ≥ 2 years of age to either chemotherapy (C) (chemoradiation ± pazopanib) or non-chemotherapy (NC) (radiation ± pazopanib) arms. It was anticipated adults would contribute the majority of enrollments on the NC arm based on prior enrollment patterns. While the C arm accrued as anticipated (with high enrollment of adults and children), the NC arm had low enrollment leading to premature closure. We report on AYA accrual (defined as 15-39 years) to the NC arm and a survey aiming to identify barriers to enrolling AYA patients onto ARST1321. Methods: Our survey was emailed to 161 adult, surgical, and radiation oncologists at large sarcoma centers. A link was sent to an online questionnaire via SurveyMonkey Inc. and responses were reviewed on their platform. Results: 33 patients enrolled on the ARST1321 NC arm, of which 24% were AYA. 25% of AYA enrollments were from non-COG adult cooperative groups. This trial arm was closed in October 2017 after 3.25 years of accrual below anticipated rates. The survey response rate was 31% with a 70% completion rate. Almost half of respondents were medical oncologists with most seeing 50-200 new sarcoma cases/year at an academic institution and 30% in a pediatric environment (divided equally between radiation and surgical oncologists). 70% of respondents have a joint collaboration with their pediatric oncology team with 23% having a joint clinic. 70% of respondents’ sites opened ARST1321 and anticipated 1-5 patients would be eligible for the NC cohort. However, 42% of respondents’ sites had zero patients enrolled on that arm. The most common reasons for not opening the study and/or not enrolling patients on the NC arm included: lack of interest, disagreement with the therapy, lack of a site investigator, premature study closure, patient/family decision, competing trials, insufficient reimbursement, and regulatory delays. Conclusions: Our survey highlights multiple barriers to enrollment of AYA onto cross-NCTN consortia clinical trials spanning the age spectrum. The information obtained will help inform investigators aiming to effectively design, enroll, and conduct similar trial efforts for AYA in the future.
Clinical trial awareness in oncology patients of diverse ethnic background: A single-institution analysis.
Authors: Valecha Gautam , Thumallapally Nishitha , El Bitar Sandy , Terjanian Terenig O. , Madrigal Louise , Longo Laura , Vaiselbuh Sarah 
Published: May 2020

e19217 Background: Clinical trials offer several advantages to the patients including access to innovative treatments with improved survival rates, closer monitoring and follow-up with removal of health disparity; and aim to advance the science of medicine. Yet, worldwide enrollment rates in cancer clinical trials have been only about 5 percent, despite the fact that a significantly higher percentage of Americans have a desire to participate in clinical trials [1, 2]. We conducted a single institution study to gain knowledge about clinical trial awareness in our cancer patient population as well as to identify the barriers within provider-consumer communication that prevent enrollment. Methods: A 10-question survey was distributed by medical assistants and surveys (n=222) were collected at the end of each clinic visit. Responders included racial/ethnic minorities and underserved patients, representative of the ethnic diversity in the Staten Island Borough of New York City. Demographic data including age, gender, zip code, race and ethnicity were recorded. Additionally, Charlson comorbidity index and tumor stage was also recorded. Results: 159/222 patients (71.62%) completed the survey. Of these patients, 47 (29.55%) answered every question on the survey, while 112/159 patients (70.44%) answered only few of the questions. The completed surveys are linked by zip code to the different boroughs of Staten Island, which allows us to identify hubs with lack of clinical trial awareness knowledge. Conclusions: Despite the several advantages for patients and medical field, enrollment rates in clinical trials remain very low. Our study results help in gaining knowledge about clinical trial awareness among oncology patients, correlated to comorbidity and tumor stage. In addition, demographic hubs with lack of knowledge are identified as targets for community outreach and education. A multilevel approach will be developed to address identified barriers that exist for patients, and will be implemented at community level, to reduce ethnic bias in trial enrollment and increase trial participation among an ethnically diverse population. References: 1. Unger JM, Cook E, Tai E, Bleyer A: The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies. Am Soc Clin Oncol Educ Book. 2016, 35:185-198. 10.1200/EDBK_156686 2. Comis RL, Miller JD, Aldigé CR, Krebs L, Stoval E: Public attitudes toward participation in cancer clinical trials. J Clin Oncol. 2003, 21:830-835. 10.1200/JCO.2003.02.105.
Perceptions of process barriers to lung cancer screening at community oncology programs.
Authors: Sutton Linda , Lotz Lisi , Horn Eileen V. , Pendergraft Trudy 
Published: May 2020

e19218 Background: Lung cancer screening (LCS) has potential to detect earlier stage cancer, favorably impacting patient outcomes, however evolving data suggest that LCS is underutilized. Because LCS is an extensive process with diverse barriers specific to each clinical setting, a multidisciplinary quality improvement (QI) initiative was undertaken to develop and test LCS processes to improve effective LCS. Baseline findings and approaches are presented. Methods: To inform the development of effective strategies to improve LCS, a survey was developed to examine perceptions and barriers to LCS across a group of community oncology programs in the Duke Cancer Network (DCN). The survey analyzed contextual, institutional, and patient factors influencing utilization of LCS. Survey results were used to support purpose-driven multidisciplinary teams to develop site-specific improvement plans for LCS with the support of QI consultants from Bite-Size QI. Results: Surveys were sent to 62 administrators and providers at 12 community oncology programs, with 36 respondents across 9 sites. LCS rates ranged between 4%-16% at participating sites. Respondents identified the lack of processes and infrastructure to support LCS as the most common challenges. Processes related to identification of LCS candidates, conduct of shared decision-making (SDM), follow up of lung nodules, and recurring screens were named specifically. Contributing factors identified were lack of robust community outreach, patient education, and protocols for providers. With regard to SDM, both administrators and providers reported systematic issues including provider time constraints and nonexistent or inconsistent identification/tracking systems, with patient compliance and health literacy as further barriers. The lack of these processes not only affected patients receiving initial LCS, but also how recurrent screenings were tracked. Conclusions: Identifying challenges in processes facilitated creation of improvement projects for participating sites. Initial improvement projects focus on patient notification of LCS results through follow up letters, integration of tracking LCS into hospital systems, development of patient education, community outreach and smoking cessation programs. Follow-up analyses will be undertaken to evaluate each approach.
Adherence to post-surgery follow-up assessment and its association with sociodemographic and disease characteristics in patients with breast cancer in China.
Authors: Feng Ran , Jing Jingfeng , Yang Haibo , Zhang Xiaojun , Li Ming , Gao Jinnan 
Published: May 2020

e19232 Background: The incidence of breast cancer has increased more than 30% in the past decades in China. Epidemiological studies based on international and Chinese data have showed that breast cancer is the most common in female malignant tumors. Breast cancer patients with early breast cancer have better survival, lower recurrence and metastasis rate due to early diagnosis and improved treatment. As an important element in the comprehensive management of breast cancer patients, follow-up can eliminate treatment-related complications, detect recurrence and metastasis as early as possible, and improve mental health and quality of life. It is increasingly recognized as a distinct phase of cancer care. However, follow-up adherence after breast surgery has not been studied in China. The aim of this study is to investigate the loss of follow-up after breast cancer surgery and its association with patients', tumor and treatment characteristics. Methods: A total of 711 patients underwent surgical treatment in Shanxi Bethune Hospital from March 2012 to May 2018 were included in this study. Baseline socio-demographic, tumor, and treatment characteristics were obtained from the hospital electronic medical records. The post-surgery follow-up was reviewed and assessed from the patients’ follow-up examination record. Factors associated with the first three-year follow-up was evaluated using logistic regression analysis. Results: The annual follow-up rate after surgery decreased gradually from 67.1% at the 1st year, 60.2% at the 3rd year to 51.9% at the 4th year, and 43.5% at the 5th year. Loss of follow-up during the first three years after surgery was significantly associated with older age >65 years(OR=2.34, 95% CI:1.14-4.82), lower medical insurance coverage(OR=4.26, 95%CI:1.77-10.25), axillary lymph node dissection(OR=2.52, 95%CI:1.39-4.55), no chemotherapy(OR=3.55, 95% CI:1.87-6.75) and no radiotherapy(OR=3.85, 95%CI:2.11-7.03). Conclusions: This study indicated that the annual follow-up rate after curative surgery for breast cancer survivors decreased significantly within five years, and that the risk of poor adherence to follow-up examinations was significantly increased in patients aged over 65 years with lower medical insurance coverage, having extensive axillary lymph node dissection, and lack of systematic treatments. These results suggest potential for improving adherence to follow-up in higher-risk subgroups and help clinicians to develop tailored patient management.
Elevating the standard of care: Impact of a regimen-level prior authorization tool on provider adherence to clinical guidelines.
Authors: Brito Rogelio Alberto , Kuklinski Geri , Angelica Patricia , Claussen Anne , Fischer Diana , Yeon Heeseon , Leprai Chiara , Karos Rebecca 
Published: May 2020

e19235 Background: New developments in oncology therapy continue to grow in complexity, fueling a dramatically rising cost of care. Traditional care models present opportunities to streamline plan sponsor management efforts, expedite therapy, and improve health outcomes. Studies suggest adherence to evidence-based standards results in higher quality care. Current plan sponsor management platforms match medical policy to individual drugs, not to combination therapy regimens and lack real-time access to standard treatment guidelines. 70% of precertification requests are submitted via antiquated, cumbersome methods such as paper and fax. Methods: CVS Health/Aetna developed a comprehensive oncology solution featuring an enterprise web-based clinical decision support prior authorization tool (Novologix) at the regimen level to reduce administrative burden and support quality care. Novologix regimens were updated via collaboration with the National Comprehensive Cancer Network (NCCN) evidence-based guidelines. Groups also entered a value-based payment (VBP) model to help support quality of care by promoting adherence to NCCN guidelines when clinically appropriate and tool utilization. Eligible members were Commercial, fully-insured members newly diagnosed with breast, colorectal, or lung cancer. Providers were offered dedicated, individual training sessions to provide education on the Novologix tool. NCCN-aligned regimens requested through the platform were automatically certified. Any non-NCCN aligned regimens received accelerated medical review by a board-certified medical oncologist with the option for an external peer-to-peer review upon denial. Providers received ongoing quality and cost of care reporting. Results: Primary in progress. N of precertification requests submitted via Novologix ( 28 requests as of 1/23/2020) - (will include graph displaying N of requests by month). N of regimens submitted via Novologix that were automatically certified (46% as of 1/23). Avg turnaround times for modified regimen requests requiring clinical review (TBD). Avg % adherence to NCCN guidelines (100% as of 1/23/20) Secondary: Total cost of care (preliminary/other leading indicator). Conclusions: By engaging oncology practices through an enhanced payer-provider collaboration and implementing an automated regimen-level precertification process we can facilitate higher-quality oncology care. Future studies will be needed to measure the impact of this program on total cost of care.