bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of curated data on electronic quality measure capture rates within CancerLinQ.
Authors: Rios Katrina Caridad , Thakkalapally Arpitha , Koskimaki Jacob , Riffon Mark , Miller Robert S. , Komatsoulis George Anthony , Potter Danielle 
Published: October 2020

307 Background: Accurate calculation of key quality measures is critical for informing high-quality, value-based cancer care that is consistent with clinical guidelines. The American Society of Clinical Oncology (ASCO)’s CancerLinQ enables oncology organizations around the US to view near-real time quality measure dashboards sourced from structured electronic medical record (EMR) data; however, use of structured data in key fields is highly variable. Unstructured content, such as progress notes, contains important clinical information on treatment and disease status, which can then undergo curation. This process involves trained data abstractors searching for key data elements through a combination of manual review and natural language processing (NLP) to extract structured data from unstructured content. We hypothesize inclusion of curated data substantially augments structured data alone by more accurately representing the patient journey, thus improving validity of quality measures across EMRs. Methods: A total of 96,399 records across 57,232 patients from 4 EMRs vendors were analyzed from 2018-2019 across structured EMR and curated data. Each record represents 1 of 7 key data elements used to calculate the Staging Documented within One Month of First Office Visit quality measure. Structured documentation of these data elements determines if a patient is concordant with the measure, meaning they were staged within 31 days of their first visit after diagnosis, or non-concordant, meaning they were not staged within the appropriate window. Results: More than a quarter of records from patients concordant or non-concordant with the measure (28.85%) had key data elements sourced from curation. In total, 33% of all records among concordant patients were sourced from curation. Relying on structured data alone would show only 67% concordance versus 97.5% concordance among curated records. This demonstrates that appropriate care may often be delivered but documentation may be missing in a significant fraction of structured EMR data, thus limiting accurate reporting capabilities. Conclusions: NLP-assisted curation can meaningfully supplement structured EMR data by providing a more accurate picture of care rendered, which can have substantial impacts on clinical care, quality reporting, and business operations. [Table: see text]
Tag you’re it! Development of a clinical decision support tool to identify NCCN regimens without a costly pathways program.
Authors: Bhardwaj Aarti Sonia , Gu Edward , Hernandez Damaris Peralta , McLean Michael , Theroux Haley Hines , Smith Cardinale B. 
Published: October 2020

308 Background: Reducing variation in care can improve outcomes and decrease costs. Evidence based medicine drives cancer guidelines and adherence promotes quality cancer care. Value based programs are based on adherence to pathways. Most institutions adopt costly cloud based clinical pathways products but none are mature products that fully integrate with the EHR and they require additional data entry. We present our simple Clinical Decision Support (CDS) tool for identifying best practice treatment protocols driven by the cancer diagnosis in the EMR for our large, multi-site, mixed academic and community cancer system. Methods: Our chemotherapy council must approve all protocols that are published in the system’s Epic Beacon library using a rigorous scoring system based on level of evidence and FDA or NCCN approval. Then each protocol is “tagged” appropriately: “Tier 1A”: Preferred Regimens/NCCN Approved; “Tier 1B”: Preferred Regimens/Chemo Council Approved (but not NCCN Approved); Tier 2: Specific Disease Management Team approved regimens; and finally “Other” or research protocols. When the oncologist enters the treatment plan in EPIC, a list of protocols are suggested, ordered by level of evidence, based on the cancer diagnosis and with the easily visible level of evidence or “tag” to allow data driven decision making. Results: We implemented our CDS tool December 12, 2019. As of mid-June, 2020 a total of 1637 treatment plans have been implemented. Of those, 1323 (81%) are Tier 1A, 310 (2%) are Tier 1B and 4 (.2%) are Tier 2. Thus demonstrating 81% adherence to NCCN approved regimens across the system, regardless of the line of treatment. GI and breast cancers were responsible for the most plans with the highest adherence to Tier 1A plans, specifically 92% among the breast cancer group. Multiple Myeloma and Sarcoma were tied for the lowest adherence rate of 58%. This data can be further stratified by medical oncologist. Interestingly, Multiple Myeloma had the highest utilization of Tier 1B protocols perhaps reflecting the rapidly changing literature that is ahead of the guidelines. Conclusions: We demonstrated adherence to NCCN protocols 81% of the time over a 6 month period and over multiple cancer types. Protocol tagging and reporting utilizing the EMR alone could be used as a powerful model for value based care. We identified disease areas that will require further education regarding evidence based treatment and can consider interventions including real time feedback to clinicians and/or best practice advisories or quality based incentives.
A provider-focused, point-of-care technology to improve clinical trial accrual.
Authors: Anand Sidharth , Larson Sarah Marie , Fischer Katrina , Glaspy John A. 
Published: October 2020

309 Background: Low accrual to clinical trials is a significant burden to advancing research efforts, particularly detrimental to patients who may benefit clinically from enrollment in a promising trial. Low accrual has been linked to a lack of provider awareness of clinical trials at the point of care and current technology solutions have not adequately addressed this important issue. Methods: We aimed to develop a system to improve clinical trial access for patients throughout UCLA Hematology-Oncology through the development of a point of care web-based tool to allow providers to easily identify available clinical trials for their patients. First, we built a comprehensive database of current clinical trials at UCLA, with special emphasis on streamlined exclusion/inclusion criteria. We incorporated this database into a front-end web and mobile-responsive tool with a user-friendly interface allowing users to rapidly identify patients eligible for clinical trial enrollment. We launched this tool 1/15/2019 to 56 oncologists at UCLA Health. Results: From 1/15/19 to 6/14/19 we had had a total of 713 unique logins to the clinical trials website. This included “academic oncologists,” those oncologists specializing in a particular disease sub-type and often a ‘hub’ for clinical trials, with an average of 6.4 logins per oncologist, and “community oncologists” with an average of 18.8 logins per oncologist over that time frame. A brief survey of users who logged in over 4 times during that time revealed that on average, 4-5 additional patients per user were screened for clinical trials not previously identified. Conclusions: Clinical trial accrual can be enhanced through improved provider awareness of available trials at the point-of-care. A well-designed user interface with features to help facilitate provider navigation to available trials and quick inclusion and exclusion criteria were critical to the success of the tool. Although the web-based tool achieved its primary purpose in improving clinical trial awareness, its utility diminished over time due to the lack of real-time updates of trial data. Based on provider feedback, if the available trial data can be updated and maintained on a regular basis, this can be a valuable tool to improve clinical trial awareness and subsequently, accrual.
Implementation of care near home model (CNH) for cancer patients in response to COVID-19 pandemic.
Authors: Jazieh Abdul-Rahman , Al Mutairi Nashmia , Al Hadab Abdulrahman , Al Olayan Ashwaq , Al Hejazi Ayman , Al Qarni Abdullah , Al Zahrani Mohsen , Shehata Hussam , Al Shami Mona , Al Raizah Abdulrahman , Gadallah Azzah , Musumadi Luhanga , Al Rabeeah Fawaz , Alotaibi Thamer , Al Ajlan Abdulaziz 
Published: October 2020

32 Background: Cancer care is heavily centered in health care facilities due to the requirements of providing complex multidisciplinary care with multiple testing and interventions. We describe our experience in implementing a new model of care to minimize cancer patients visit to health care facilities and to reduce the risk of infections and to decrease the pressure on the health care system. Methods: In response to the COVID-19 pandemic, we reengineered the cancer care process to reduce patients visit to the hospital by the implementation of a Care Near Home (CNH) Model, which comprises of four components: virtual clinic, laboratory testing near home, shipping medications and supplies, and involving local health care facilities. The effectiveness and acceptance of this new model has been assessed by the delivery of timely care successfully and assessing the satisfaction patients and healthcare providers. Results: On March 18, 2020, we launched the virtual clinics followed by different components of the model. The number of virtual clinic visits has increased significantly from 399 visits in March to 1107 in April 2020. More the 90% of physicians and patients who responded to the survey expressed their acceptance and satisfaction with the virtual clinic services. Medications were shipped to total of 603 patients. Of those, 578 (96%) patients received their medications (378 patients outside city, 200 patients inside city of which, 95% received medications within 24 hours). Only 25 (4%) patients did not receive their medications and we arrange for alternative solutions. Laboratories in various regions were set up to perform the tests for our patients and to communicate the results through our electronic healthcare records system. The process of ordering and performing the test were piloted with success and now we are at the scaling up phase. Conclusions: Although the implementation of CNH Model was driven by COVID-19 pandemic, it will be integrated in our work process and utilized as a long term approach to manage many of our patients because it is more convenient to them and more cost effective to the health care system.
Feasibility, delivery, and acceptance of a multidisciplinary survivorship care model based in an Asian national ambulatory cancer center: A six-month review.
Authors: Ke Yu , Neo Patricia Soek Hui , Loh Kiley , Yang Grace Meijuan , Ho Shirlynn , Tan Yee Pin , Ramalingam Mothi Babu , Quah Daniel , Chew Lita , Si Phebe , Tan Yung Ying , Tay Beng Choo , Koh Suzanne Poh Geok , Chan Alexandre 
Published: October 2020

34 Background: Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) is a multidisciplinary survivorship care model launched at the National Cancer Centre Singapore, the largest ambulatory cancer centre serving 70% of adult cancer patients in the public sector. ACCESS employs routine distress screening to triage patients with varying care needs and complexities. This study aims to examine the feasibility, delivery, and acceptance of ACCESS in providing appropriate service referrals to cancer patients in clinical settings. Methods: As part of an ongoing evaluation, we evaluated ACCESS for a 6-month implementation period between September 2019 and February 2020. Feasibility was assessed by proportions of (1) eligible breast and gynecological cancer patients who completed the locally adapted Distress Thermometer (DT) screening tool, (2) highly distressed patients, and (3) highly distressed patients requiring multidisciplinary meetings (MDM). Delivery was characterized by the mode and number of supportive care team (SCT) reviews required. Acceptance rates of SCT reviews by distressed patients and the uptake rate of service referrals recommended by the SCT were tabulated. Results: ACCESS screened 1074/1471 (73.0%) of all eligible patients within the 6-month period and identified 239/1074 (22.3%) as highly distressed for follow-up with the SCT. Eventually, 84.5% agreed to SCT review, with approximately one-fourth (26.7%) requiring MDM reviews. The majority (62.4%) of all distressed patients were identified at their first DT completion, whereas 19.8% and 7.4% were identified at their second and third completions respectively. The most common modes of follow-up were phone reviews (49.9%) and face-to-face in clinic waiting areas (48.6%). The SCT recommended 80 referrals to distressed patients for the following services: psychosocial (27.2%), cancer rehabilitation (5.9%), and home hospice (5.0%). The acceptance rates of the referrals for psychosocial, rehabilitation, and hospice services were 43.6%, 75.0%, and 80.0% respectively. Conclusions: ACCESS is a feasible model for triaging Asian cancer patients based on distress levels, and identifying complex patients requiring care personalization through MDM. The poorer acceptance rate of psychosocial services highlights patients’ preference for interventions targeting physical than psychosocial issues. Future studies should explore whether the uptake of psychosocial services is higher in the post-COVID era.
Addressing reproductive health needs of cancer patients: The pilot experience of pioneering oncofertility clinic in Saudi Arabia.
Authors: Alrabiah Hayat Ahmed , Abdelhafeiz Nafisa , Al Olayan Ashwaq , Jazieh Abdul-Rahman 
Published: October 2020

37 Background: Fertility and reproductive health issues are commonly encountered in cancer patients and survivors and unfortunately, they are not systematically addressed in many cancer care centers. We are reporting the initial experience in our dedicated Oncofertility Clinic that was established to address all reproductive and fertility issues for all oncology patients at our cancer center. Methods: We launched the first dedicated oncofertility clinic in the region on April 2018, staffed by a consultant of obstetrics and gynecology with the help of a team from in vitro fertilization (IVF) unit and a medical oncologist. It is held on a weekly basis and receives referral from medical oncology, hematology, stem cell transplant and radiation oncology. Eligible patients are males and premenopausal females going for chemotherapy or radiation therapy aiming for fertility preservation or cancer survivors who completed treatment and complaining of infertility problems. The clinic provides fertility preservation through the following procedures: Oocytes freezing (OF), in-vitro fertilization (IVF), sperm freezing, and ovarian transposition. Oncofertility care also includes management of sexual and hormonal dysfunction, and contraception methods. We are capturing the demographic, clinical data of all patients who were served in the clinic and the number of interventions and procedures that they underwent. Results: Between April 2018 and April of 2020, the clinic served 100 patients 60% were female, Median age was 35 years (16 -39). Diagnoses were distributed between breast cancer (36%), lymphoma (10%), and sickle cell anemia patients undergoing hematopoietic stem cell transplant (10%). The table depicts the types and number of procedures performed on these patients. Conclusions: Our pilot experience revealed the critical need of such clinic to help patients in fertility preservation, management of symptoms of gonadal toxicity. Future plans include implementation of systematic screening approach cancer populations who will benefit from the services and monitor the long- term impact of the clinic on the served patients. [Table: see text]
Multiple myeloma (MM) therapy within a Medicare-insured patient population: Role of care setting and oncologist sub-specialization in hematologic malignancies.
Authors: Davidoff Amy J. , Long Jessica B. , Huntington Scott F. 
Published: October 2020

38 Background: Dramatic increases in oncology practice consolidation with hospitals may affect care setting and whether patients see oncologists that specialize in their cancer, with downstream effects on treatment patterns. This may be particularly true for MM, where approval of new immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs), coupled with evidence supporting PI-IMiD combinations, maintenance (MT), and stem cell transplant (SCT) among fit patients, have expanded options, complexity and lines of therapy (LOT). Methods: We selected adults with MM diagnosis (dx) between 07/07-12/15 from the SEER-Medicare linked database. We required continuous Medicare Parts A and B enrollment and no HMO/PPO coverage from 12 months prior to dx (1 month prior for Part D) through death or end of study (12/16) and MM therapy initiation w/in 12 months post dx. Outcomes including LOT1 PI-IMiD combination, SCT, MT, and any LOT2, 3 or 4 were constructed using claims indicators for oral and IV drugs and receipt dates. Provider setting was assigned as academic and/or NCI cancer center, non-teaching hospital, or community (non-hospital) based on the most recent oncologist E and M visit prior to LOT1 initiation. Percentage of patient panel with hematologic malignancies (Heme%) was calculated for each oncologist, using a pooled sample of 11 major cancer sites reported in SEER-Medicare. Multivariable logistic regressions included care setting, %Heme, with controls for demographics, health status, and diagnosis year. Results: The cohort (n = 4930) was 14% Black, and 51% age ≥75 years. Care setting was 23% academic, 14% non-teaching hospital, and 63% community; community setting decreased from 72 to 58% during observation period (2007 to 2015). Mean Heme% (31% overall) was higher in academic hospitals (44%) compared with community practices (27%; p < .001). LOT1 PI-IMiD, LOT 2, 3 and 4 were received by 21%, 55%, 31% and 18% respectively, with 53% MT, and 7% SCT. Higher %Heme was associated with increased likelihood of LOT1 PI-IMiD, SCT, LOT3, and LOT4. Relative to academic/NCI, community care was associated with higher adjusted odds for LOT1 PI-IMiD: aOR 1.33, p < .001; but lower odds for any LOT4: aOR .67, p = .001). Conclusions: Using a novel measure of oncologist sub-specialization in hematologic malignancies, we found positive associations with receipt of initial PI-IMiD therapy and ongoing LOTs in a Medicare insured population treated for MM. Surprisingly, care in a community setting was associated with recommended initial PI-IMiD therapy, but fewer LOTs.
Testicular cancer management: Population-wide, rapid case ascertainment to drive early expert engagement and reduced practice variation.
Authors: Harzstark Andrea , Herrinton Lisa J. , Walker Lauren C. , Liu Liyan , Kolevska Tatjana , St. Lezin Mark , Nichols Craig R. , Daneshmand Siamak , Presti Joseph 
Published: October 2020

39 Background: Research priorities in germ cell tumor (GCT) management have moved sharply from therapeutic improvements to cancer care delivery research and biomarker-based decision making. Early intervention with centralized decision support and oversight by expert teams result in best therapeutic outcomes and survivorship with decreased resource utilization. We describe Kaiser Permanente Northern California’s (KPNC) re-organization of care delivery through rapid case ascertainment and early expert input, as well as early results of reduction in practice variation and system-wide practice change. Methods: In 2016, KPNC reorganized oncology from a distributed generalist model to a model led by a centralized multidisciplinary expert team to share in initial and ongoing care delivery for all GCT patients in the system. Central to the re-organization was rapid ascertainment of the entire population of patients with GCT within the system and early expert engagement in treatment decision-making. Results: Between May 2016 and June 2018, 274 GCT patients were recorded in the tumor registry, of whom 69% were < 40 years of age, 16% were non-white, 56% had seminoma and 63% had stage 1 disease. Rapid case ascertainment identified 89% (95% CI, 86-93%) of the cases, increasing from 79% in 2016 to 97% in 2018 as false negatives were identified and used to improve the case finding algorithm. The overall positive predictive value was 57% (52-62%) and number needed to detect was 1.75 (1.62-1.91). Of the 274 cases, 92% (89-95%) were engaged by the expert team. In addition, the team reviewed 61 testicular cancer patients who had recurrences or metastatic cancers. Among 177 patients with stage I seminoma, the preferred use of active surveillance over adjuvant chemotherapy or radiation therapy rose from 48% (95% CI, 35-62%) in 2015 to 87% (75-99%) in 2018 (p = 0.0005). For patients with nonseminoma, the rate of the preferred option of retroperitoneal lymphadenectomies being performed by a high volume urologic surgeon increased markedly from 62% in 2015 to 95% in 2018. Conclusions: To our knowledge, the KPNC re-organization of GCT care delivery with comprehensive rapid case ascertainment is unique for integrated health care delivery systems in the USA. While early, KPNC has a working platform for early, expert multidisciplinary review and bidirectional communication with local care teams for population-based care. Early evidence points to system-wide reductions in practice variation and improvements in practice.