bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation and uptake of an interactive virtual online tumor board across NCI-Cancer Centers.
Authors: Kalra Maitri , McCann Kelly Elizabeth , Karuturi Meghan Sri , Alvarez Jean , Parkes Amanda Marie , Wesolowski Robert , Wei Mei , Mougalian Sarah Schellhorn , Durm Greg Andrew , Qin Angel , Trivedi Meghna S. , Armaghani Avan J. , Wilson Frederick Hugh , Iams Wade Thomas , Cecchini Michael , Turk Anita Ahmed , Soliman Hatem Hussein , Tripathy Debu , Housri Samir , Housri Nadine ,   The Mednet NCI Tumor Board Project Collaborators
Published: October 2019

272 Background: Expert knowledge is often shared among academic oncologists at tumor boards (TBs) at National Cancer Institute Designated Cancer Centers (NCI-CCs), but not documented or made accessible to community oncologists. Using an oncologist-only question and answer (Q&A) website, we sought to disseminate expert insights from TBs at NCI-CCs to provide educational benefit to the oncology community. Methods: A process was designed with faculty at 11 NCI-CCs to document and share discussions from TBs focused on areas of clinical complexity and practice variation on theMednet.org, an interactive Q&A website of over 8,700 US oncologists. One faculty member from each TB was selected as a site leader. She or he distilled discussions about patient management from the TB into a question that addressed the clinical situation being discussed. After the question was posted, faculty at the participating NCI-CCs were asked to answer the question on theMednet. Answers were peer reviewed, indexed, stored and disseminated via email newsletters to registered oncologists. Community engagement was measured by Q&A page views, upvotes of Q&A, and poll participation. Results: A total of 15 Breast, Thoracic, and Gastrointestinal programs from 11 NCI-CCs participated. Between 12/2016 and 5/2019, faculty highlighted 146 questions from their TBs. Q&A were viewed 43,291 times by 3,585 oncologists including 2,264 community oncologists. One hundred and eighty-four answers are posted by 56 academic physicians and peer reviewed by 76 academic physicians. One hundred and eighty-five publications were cited. Community oncologists upvoted Q&A 808 times and voted in 45 polls related to the questions 1,667 times. Viewership of NCI-CC Q&A increased by 419% over time. Q&A were repeatedly searched and viewed, with 90% of all TB Q&A viewed every month. Conclusions: Via the online Q&A theMednet platform, NCI-CC providers effectively made expert knowledge easily accessible to community oncologists across the US. Timely access to evidence based recommendations from expert faculty can inform future practice choices in the community. [Table: see text]
Implementation of a post discharge video visit telehealth initiative.
Authors: Burdette Samantha , Handley Nathan , Birchmeier Katlin , Basu Mallick Atrayee , Filicko Joanne , Binder Adam 
Published: October 2019

274 Background: Telehealth is increasingly used as a means to influence four domains of healthcare: access, cost, experience, and effectiveness. The medical oncology service at Thomas Jefferson University implemented a post-discharge video visit program for all patients discharged from the Advanced Practice Provider (APP) service following scheduled inpatient chemotherapy. Data were collected to assess clinical interventions that occurred. Barriers to participation in the visits were also assessed. Methods: All patients on the APP service were screened for eligibility for a post discharge video visit. Patients who were eligible (requirements: reliable internet connection, access to a smart device, active patient portal account, English language speaker) had video visits scheduled prior to discharge. Data regarding the visits (including patient demographics, eligibility, patient interest, and interventions performed) were recorded. Results: One hundred forty nine admissions were included in the analysis. Sixty (40.27%) resulted in the scheduling of a post discharge video visit; 37 (61.67%) of these visits were completed. Medication reconciliation/education occurred in 22 encounters (59.46%); symptom management occurred in 17 encounters (45.95%).The most common reason for not completing a visit was the patient not answering the video visit call (17 encounters (73.91%)). Of the 89 encounters in which patients were ineligible or declined, technological barriers were the most common reason for not participating (29.21%), followed by disinterest (17.10%) and non-English speaking (16.85%). Conclusions: While significant barriers to implementation of post-discharge video visits exist, when visits did occur, frequent interventions occurred. Further research to understand and alleviate barriers to telehealth implementation are merited. Care must be taken to avoid creating disparities among patient populations.
Impact of telemedicine on colonoscopy education among veterans.
Authors: Khuc Thi , Jackson Christian , Chao Daniel 
Published: October 2019

276 Background: The VA Loma Linda Healthcare System (LLVA) offers an in-person colonoscopy education class (IPCC) and a telehealth based education class to patients living closer to outlying VA designated Community Based Outpatient Clinics (CBOCs). We noticed a significant number of cancellations and no-shows for colonoscopy from patients who sought care from CBOCS. We developed a telehealth based colonoscopy class (TBCC) to be given at CBOCs. The primary aim of the study was to determine effectiveness of TBCC compared to IPCC on class attendance rates, colonoscopy attendance and quality measures of colonoscopy. Methods: We reviewed records of 1429 LLVA and CBOC patients referred for colonoscopy class from April 2014 to April 2015. Primary end points were polyp detection rate (PDR), adenomas detection rate (ADR) and adenocarcinoma detection rate (ACDR). Secondary endpoints were attendance to TBCC and IPCC and attendance to colonoscopy. Attendance was defined as compliance with the first scheduled appointment. We examined age, BMI, sex, race, and indication for colonoscopy in the IPCC and TBCC populations. Results: TBCC attendance rate was higher than IPCC (p = 0.001). There was no difference in attendance to colonoscopy (p = 0.50). Patients receiving primary care at CBOCs more likely chose TBCC; patients receiving primary care at LLVA more likely chose IPCC (92.53% vs 24.77%, p < 0.0001). African Americans and Hispanics more likely chose IPCC; Whites more likely chose TBCC (p = .01). Patients with family history of colorectal cancer or bright red blood per rectum more likely chose IPCC (p = 0.004, p = 0.008). Sixty eight percent of colonoscopy preparations were noted to be good. There was no difference in the number of good preparations between TBCC and IPCC groups (94.3% and 96%, p = 0.025). ADR was higher in patients who received IPCC (44.55% and 52.17%, p = 0.02). There was no significant difference in PDR and ACDR between TBCC and IPCC groups. Conclusions: A TBCC program can increase patient attendance to colonoscopy preparation training without negatively affecting quality of colonoscopy preparation. Prospective, randomized studies on differences in adenoma detection and distance from home residence on class and colonoscopy attendance rates is needed.
A novel tool to monitor adherence to oral oncolytics: A pilot study.
Authors: Sun Wendy , Reeve Rebecca , Ouellette Timothy , Stutsky Martha , De Jesus Rachel , Huffer Michael J , Mougalian Sarah Schellhorn 
Published: October 2019

286 Background: Non-adherence is an important issue in cancer care as more oral cytotoxic and targeted agents become available. Although oral therapies may be more convenient for patients, measuring and optimizing adherence is challenging. The Nomi system records real-time medication taking behavior from a "smart" prescription bottle and displays the data on a web-based interface. Nomi can also communicate with patients via text message to intervene in cases of non-adherence. We report the results of a 28-patient pilot study aiming to assess Nomi’s ability to assist patients taking capecitabine, an oral chemotherapy agent with a complex, cyclical regimen. Methods: Eligible patients were prescribed capecitabine for breast, colorectal, pancreatic, or biliary cancer. The study had a pre-intervention stage, during which patients were monitored, and an intervention stage, in which the text messaging feature was enabled. Adherence was defined as the number of correct doses (both timing and quantity) over the total number of prescribed doses. Conversions were events in which patients took a dose after receiving a text intervention (from Nomi). We defined three categories of patients by percent change in adherence: category 1 ( > 8%), category 2 (-8% to 8%), and category 3 ( < -8%). Results: We collected data from 28 patients (24 pre/post and 4 pre-only). On average, patients were 84% adherent (N = 28; SD = 11%). During pre-intervention, patients had a self-adherence of 89% (SD = 12%), and afterwards, they had an average adherence of 90% (SD = 6%). Most of the patients in category 1 demonstrated a substantial conversion rate ( > 35%). Patients in category 1 tended to live in regions with lower average household income (Mean = $58,937) than those in category 2 (Mean = $77,482) and category 3 (Mean = $90,972). Of survey respondents, 56% indicated that they would want to continue using Nomi, while 67% indicated that they would recommend it to others. Conclusions: This innovative technology is able to monitor, measure and intervene for patients taking capecitabine in real-time. Adherence overall was high, and some patients appeared to benefit more from text message interventions. Future work should focus on patients deemed high risk for non-adherence.
A nutrition-focused quality improvement program to improve rate of documented nutrition plan at a safety-net hospital gastrointestinal (GI) oncology clinic.
Authors: Levonyak Nicholas , Hodges Mary P , Broome Nicole , Beg Muhammad Shaalan , Kainthla Radhika , Sanjeevaiah Aravind , Sadeghi Navid , Pandey Neha , Mhoon Verca , Cox John Vernon , Kazmi Syed Mohammad Ali 
Published: October 2019

289 Background: Patients with GI cancer have amongst the highest rates of malnutrition, which contributes to decreased quality of life, increased morbidity and mortality, as well as higher healthcare costs. In the GI Oncology clinic at Parkland Health and Hospital System (PHHS), the number of patients with a documented nutritional plan by a registered dietitian was 7%, and there was no standardized screening method for malnutrition in place. Methods: The aim was to increase the rate of documented nutritional assessment by a registered dietitian to 25%. Multidisciplinary sessions involving physicians, registered dietitians, registered nurses, and hospital administration were arranged to identify barriers to nutritional interventions for GI Oncology clinic patients. Results: Prior to QI interventions, between October-December 2018, the total number of GI cancer patients referred to registered dietitian clinic was 11- 30 referrals, which accounted for 7-10.1% of GI cancer patient in the respective month. As part of first PDSA cycle, a registered-dietitian was assigned to GI oncology clinic. The total number of documented nutrition plan after first intervention was 22 GI cancer patient (15% of GI cancer patients). We then developed an adapted-version of the Malnutrition Screening Tool (MST) and implemented it through the institute electronic medical record. The nursing staff and physicians were educated about administering the screening tool and the referral process to a registered-dietitian after a positive MST screen. After the first month during which MST was implemented, the rate of nutritional assessment increased to total of 20.5% of GI cancer patients (total 37 referrals). Twenty out of the 37 referrals (54%) were due to the positive MST screening tool. Conclusions: Through a nutrition focused QI program, we doubled the rate of a documented nutritional plan for PHHS GI cancer patients in a month of starting the 2nd PDSA cycle intervention. Through future PDSA cycles, we plan to further increase patient access to nutritional assessments and then broaden our efforts to the entire PHHS oncology clinic.
Quality improvement and implementation science in cancer care: Identifying areas of synergy and opportunities for further integration.
Authors: Check Devon , Zullig Leah L. , Davis Melinda , Stover Angela M. , Davies Louise , Schroeck Florian Rudolf , Fleisher Linda , Chambers David , Proctor Enola , Koczwara Bogda 
Published: October 2019

29 Background: Efforts to improve cancer care delivery have been driven by two approaches: quality improvement (QI) and implementation science (IS). QI and IS have developed independently but have potential for synergy. To inform efforts to better align these fields, we examined 20 cancer-related QI and IS articles to identify differences and areas of commonality. Methods: We searched PubMed for cancer care studies that used IS or QI methods and were published in the past 5 years in one of 17 leading journals. Through consensus-based discussions, we categorized studies as QI if they evaluated efforts to improve the quality, value, or safety of care, or IS if they evaluated efforts to promote the adoption of evidence-based interventions into practice. We identified the 10 most frequently cited studies from each category (20 total studies), characterizing and comparing their objectives, methods – including use of theoretical frameworks involvement of stakeholders – and terminology. Results: All IS studies (10/10) and half (5/10) of QI studies addressed barriers to uptake of evidence-based practices. The remaining five QI studies sought to improve clinical outcomes, reduce costs, and/or address logistical issues. QI and IS studies employed common approaches to change provider and/or organizational practice (e.g., training, performance monitoring/feedback, decision support). However, the terminology used to describe these approaches was inconsistent within and between IS and QI studies. Fewer than half (8/20) of studies (4 from each category) used a theoretical or conceptual framework and only 4/20 (2 from each category) consulted key stakeholders in developing their approach. Most studies (10/10 IS and 6/10 QI) were multi-site, and most were observational, with only 4/20 studies (2 from each category) using a randomized design to evaluate their approach. Conclusions: Cancer-related QI and IS studies had overlapping objectives and used similar approaches but used inconsistent terminology. The impact of IS and QI on cancer care delivery could be enhanced by greater harmonization of language and by promoting rigor through the use of conceptual frameworks and stakeholder input.
Improving the chemotherapy consent: From paper to tablet.
Authors: Bhardwaj Aarti Sonia , Parra Jessica , Rampertaap Kavita , FitzPatrick Katherine , Caridi Raina , Liu Mark , Casani Victoria , Berizzi Donna , Isola Luis M. , Smith Cardinale B. 
Published: October 2019

298 Background: A comprehensive chemotherapy informed consent process improves shared decision-making. Additionally, the Oncology Care Model (OCM) emphasizes providing patients with a documented care plan that contains the 13 components in the Institute of Medicine Care Management Plan. Within our health system, we incorporated the care plan into our existing chemotherapy consent process and utilized technology to increase compliance and reduce administrative burden. Methods: Our 2 phase PDSA included: 1) updating our existing paper chemotherapy form with the 13 components of the IOM care plan and then 2) piloting an electronic version of the chemotherapy consent form. We updated our new chemotherapy consent with the addition of Prognosis, Expected Response to Treatment, Potential Effect on Quality of Life, Potential Benefits/Goals of Treatment, and added more options for potential side effects/harm. Given the increased administrative burden, we created and piloted the use of an electronic version of the consent form in our breast oncology program. Results: Baseline, monthly random chart audit of 20-40 patients revealed compliance with completing every question of the paper chemotherapy consent at 30% of all patients receiving IV chemotherapy at our cancer center that month- 7/2018. When the new chemotherapy consent incorporating the IOM elements was rolled out, compliance initially rose to 50% (8/2018), however the following months dropped to 10-20% (9-11/2018) and then back up to 41% briefly (12/2018). The results were low and inconsistent. A pareto chart confirmed that redundancy and too many questions were the reasons for under-completion. By auto-populating fields for certain questions on the paper consent, compliance increased to 75% (2/2019). Finally within our breast cancer pilot group our compliance rose to 100% (3-4/2019), by converting to an electronic form with the maximum options for auto-population and drop-down selections for certain fields. Conclusions: Incorporating regulatory requirements into an existing workflow can reduce administrative burden. The use of innovative technology can further increase clinician and OCM compliance while delivering value to patients.
Using Lean methodology to improve the time to antibiotics in oncology patients on chemotherapy who present to the ED with neutropenic fever.
Authors: Byrne Brian J. , Bailey Frederick , Montanaro Pat , DeFusco Patricia Anne 
Published: October 2019

31 Background: Neutropenic fever is a medical emergency. Delays in treatment can lead to increase in morbidity, mortality, and increase length of stay. The American Society of Clinical Oncology currently recommends that antibiotics be prescribed within 60 minutes of triage. Literature review shows through a multidisciplinary effort involving the ED, lab, oncology, and pharmacy significant improvement in time to antibiotics can be achieved. Since many patients with neutropenic fever present with sepsis, these guidelines also will need to be followed. Methods: Three PDSA cycles were conducted. The first involved education of the ED staff on the importance of treating neutropenic fever and using the correct antibiotic. The second PDSA cycle involved the laboratory and the calling of critical white counts and low neutrophil counts. The third PDSA involves patient education on the importance of temperature monitoring and reporting they are on chemotherapy to ED staff. Results: Baseline data show only 33% of patients receive the correct antibiotic and the average time to administration is 3 hours and 41 minutes. Results of the quality improvement project show a substantial improvement in time to antibiotic administration to 1 hour 58 minutes and an increase in the percentage of patients who receive the correct antibiotic. The time from the specimen received in the lab until critical called also improved from 1 hour 14 minutes to 18.5 minutes. Conclusions: This quality improvement led to a significant improvement in time to correct antibiotics, but several additional steps need to be taken to meet ASCO guidelines. [Table: see text]
Got stage fright? A fellow-led initiative to improve cancer staging documentation.
Authors: Velazquez Manana Ana I. , Banerjee Rahul , Kambhampati Swetha , Parks Anna , Brondfield Sam , Mulvey Claire , Cinar Pelin 
Published: October 2019

310 Background: Accurate cancer staging is essential for estimating prognosis, guiding treatment, populating cancer registries, and assessing clinical trial eligibility. Hence, timely staging of new solid oncology patients (NSOP) is an ASCO QOPI priority. At our institution, baseline review of staging documentation revealed fellows staged only 47% of NSOP, generally as unstructured free text. During the 2017-18 academic year, our structured electronic medical record (EMR) staging tool (ST) was used in only 11% of NSOP. We used Quality Improvement (QI) methods to improve structured EMR staging documentation rates of NSOP seen by fellows during the 2018-19 academic year. Methods: A fellow focus group identified poor integration of the EMR ST as root cause of our low staging rates. We set a cumulative goal of 70% structured EMR staging of NSOP within 1 month of initial visit as our target (50% increase from baseline). We incorporated the EMR ST into our visit workflow and used promotional flyers and fellow orientation to introduce our QI initiative. Staging rates were tracked by EMR-generated reports. We used periodic emails and QI-specific boards to disseminate progress among our oncology practices. Fellows were anonymously surveyed for feedback. Results: Over an 8-month period, the cumulative rate of NSOP staging by fellows increased from 47% to 70% (Table). Statistical process control analysis showed special-cause variation in July 2018 (low performance) and December 2018 (high performance). Fellow feedback highlighted the educational value of this QI intervention and identified incomplete workup as a barrier to staging. Conclusions: Our fellow-led QI intervention achieved our goal of leveraging an existing EMR tool to increase staging documentation. In addition, this QI intervention facilitated fellow education and use of data for clinical and research purposes. Future steps include ensuring sustainability and expansion into our hematology clinics. [Table: see text]
Prevalence of anemia and compliance to the National Comprehensive Cancer Network guidelines for workup and treatment of anemia among patients with gynecologic malignancies.
Authors: Hufnagel Demetra , Mehta Sumit , Ezekwe Chinyere , Brown Alaina J. , Prescott Lauren S. 
Published: October 2019

32 Background: The National Comprehensive Cancer Network (NCCN) recommends prompt evaluation of anemic patients with hemoglobin (Hb) ≤ 11g/dL. There are a paucity of studies evaluating compliance with the NCCN guidelines. Our objective was to investigate the prevalence of anemia among patients diagnosed with gynecologic cancers and assess compliance with NCCN guidelines. Methods: We performed a retrospective cohort study of patients diagnosed and treated with gynecologic cancer at our institution from 2008-2018. Tumor-registry-confirmed cancer cases were identified using ICD codes from the Synthetic Derivative (SD) database which is a de-identified copy of our institution’s electronic medical record. Patients were included if they were between the ages of 18 and 89, had their initial care at our institution, and had a Hb within the first 6 months of diagnosis. Dual primaries were excluded. Anemia was defined as Hb ≤ 11g/dL. Anemia was graded using the CTCAE v.4.0. Absolute and possible iron deficiency were defined by NCCN Guidelines. Results: We identified 1031 patients who met our inclusion criteria. The median age was 61 years (range 20 - 86). The most common malignancy was uterine cancer 509 (49%) followed by ovarian 262 (25%), cervical 133 (13%), vulvar 107 (10%) and vaginal 20 (2%). Of the 1031 patients in our study, 662 (64%) were noted to be anemic within six months of diagnosis. Of these patients 128 (19%) were noted to have grade 1, 309 (47%) grade 2, and 225 (34%) grade 3 anemia. Of those who were anemic, 90 (14%) underwent any workup for anemia, of which 63 (10%) had iron studies performed. Of those with iron studies performed, 7 (1%) patients had absolute iron deficiency and 24 (4%) had possible iron deficiency. Despite the small percentage of individuals with anemia evaluation, 266 (34%) patients received treatment of anemia. Treatments included: oral iron 47 (7%), IV iron 6 (1%), and blood transfusion 213 (32%). Conclusions: Anemia is pervasive among gynecologic cancer patients, but compliance with NCCN guidelines is low. Our data suggest there are opportunities for improvement in evaluation and management of anemia among gynecologic cancers.