bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a mortality risk predictive analytics model.
Authors: Broussard Stephanie Broadnax , Hoverman John Russell , Wilfong Lalan S. , Mikan Sabrina Q. , Books Holly , Ortega Lance , Jensen Terry Lynn , Toth Sara , Vo Duc 
Published: September 2021

211 Background: Improving the quality of End of Life (EOL) care continues to be a challenge. Enhanced prognostic awareness is critical for all members of the clinical team. In December 2020, The McKesson Advance Care Planning Enrollment eXtended (APEX) mortality risk predictive analytics model was implemented to improve prognostic awareness in OCM population and improve the timing of initiation of end of life care. (See ASCO 2021 abstract #1560). Methods: The APEX tool was provided in collaboration with the McKesson/US Oncology network analytics team. A process was established for dissemination of the report information. In the pilot, 12 practice locations with varying community landscapes, socio-cultural dynamics, and site clinical personnel resources were selected. At each site clinical leads and physician champions were selected. Education was provided on the tool, prognostic variables, and appropriate interventions. Biweekly, each site was provided a list of stratified patients based on their risk of mortality within the next 90 days. Patients that were identified as “very high” or “high” risk were reviewed by the clinical teams and discussed in routine huddles. Physicians and teams reported their planned interventions before and after mortality risk identification. Results: In the pilot, 105 patients were identified as very high or high risk. Reported interventions included the option to continue treatment, ACP Discussion, hospice referral/enrollment, palliative care referral, or continue close monitoring. Prior to the report, 14 identified patients were admitted to hospice and 30 patients had 1 or more advance directives documented. For 26 patients, treatment changes occurred including hospice enrollment, reduction in chemotherapy dosage, change in regimen, or initiating intensive monitoring. 23 patients indicated on the report expired in the interim between generation of the report and receipt by the clinic. No changes in treatment were made in 22 patients. There was physician reported disagreement with the mortality risk assessment in 4 patients. Conclusions: We describe implementation of a mortality predictive model in our practice. The care teams found the tool useful to identify patients at high risk of mortality. Interventions were varied and we will track the outcomes based on intervention. We are using the information from the pilot to continue refining the tool and implementation.
Results of a multistate, multi-institution implementation of a multidisciplinary cancer conference quality measurement tool.
Authors: Simpson Lijo , Mathew Anju , Wojciechowski Robert , Hill Irina 
Published: September 2021

212 Background: The 2006 ASCO and the ESMO consensus statement on quality cancer care defined the delivery of multimodality treatment by a multidisciplinary team of appropriately skilled health professionals as an essential component of quality cancer care. Furthermore, MDCs have demonstrated improved survival in breast, head and neck, ovarian and colorectal cancers. Despite these advantages, health care systems struggle to implement and sustain MDCs due to the heavy burden imposed by the required work processes. We report on the large-scale utilization of a propriety quality measurement platform OncoLens to run MDCs across the country. Methods: Technology quality metrics were collected from the ongoing daily usage of the platform including cancer characteristics, care team utilization metrics, average attendance, quality metrics collected for accreditation and clinical trials matching on the OncoLens platform. Results: The virtual platform was accessible to around 8000 providers across the United States. In 2020, 13771 cases were discussed. Attendance of the required specialties for high quality care of Medical Oncology, Radiation Oncology, Surgery, Pathology and Radiology was attained, with the average conference attendance being 14. Race/ethnicity data on the cases revealed White (9197, 67%), Black (1817,13%), Hispanic (363,3%) and Other (2356,17%). Optional quality metrics were collected during discussions for CoC, NAPBC and NAPRC accreditation. These included NCCN guidelines discussed, Staging discussed, clinical trials discussed, Genetics discussion, palliative care discussion, rehabilitation services, reproductive counselling discussed, psychosocial counselling discussed, nutritional counselling discussed, reconstructive surgery discussion, tobacco cessation discussion across General and Site-specific conferences. Most of the case presentations were prospective. This format does enable cancer programs to collect quality metrics around Cancer program accreditation by the American College of Surgeons. 66% of patients discussed potentially matched to clinical trials during the discussion. Conclusions: A technology platform can assist cancer programs to collect quality metrics around cancer care. This gives them the ability to run data driven quality programs targeting specific quality metrics. Hispanics have a lower percentage of cases presented at MDC compared to other race/ethnicities. It is possible to have high quality discussions and attain metrics for Commission on Cancer accreditation utilizing a virtual platform.
Rate of venous thromboembolism in gynecologic patients on an ERAS pathway.
Authors: Taylor Jolyn Sharpe , Iniesta-Donate Maria , Cain Katherine , Lasala Javier , Mena Gabriel , Zorilla Vaca Andres S. , Meyer Larissa , Ramirez Pedro T. 
Published: September 2021

214 Background: Venous thromboembolism (VTE) is a serious and potentially life-threatening complication of surgery. An Enhanced Recovery After Surgery (ERAS) program is a multimodal care pathway meant to facilitate faster recovery from surgery. ERAS protocols include mechanical and pharmacologic VTE prophylaxis and rapid return to ambulation. Our objective was to evaluate the rate of symptomatic VTE on an ERAS pathway among patients undergoing open and minimally invasive gynecologic surgery (MIS). Methods: Data was collected prospectively on patients undergoing gynecologic surgery on the ERAS pathway at a single academic institution between November 1, 2014 and March 31, 2021. For patients undergoing MIS data were collected from February 1, 2016 to March 31, 2021. Patients undergoing emergency surgery or requiring therapeutic anticoagulation prior to surgery were excluded. For planned open surgery, patients received heparin prophylaxis prior to surgery, sequential compression device (SCD) during surgery and goal directed fluid management. If also diagnosed with malignancy, patients received extended VTE prophylaxis with low molecular weight heparin for 28 days after surgery starting postoperative day 1. For planned MIS, patients received SCD and goal directed fluid management. Descriptive statistics, univariate and multivariate statistical analyses were performed. Results: Of the 3,932 patients, 2,016 (51%) underwent laparotomy, 1,541 (39%) laparoscopy and 375 (10%) robotic approach. The incidence of thromboembolism was 0.5% (N = 21) overall, 0.8% (N = 17) with open approach and 0.2% (N = 4) with MIS approach. Among laparotomy patients, there was 88% compliance with preoperative heparin prophylaxis. Characteristics associated with developing a VTE were black race, malignancy, open surgical approach, surgical time, surgical complexity, and receipt of intraoperative blood transfusion. On multivariate analysis, black race and transfusion remained associated with VTE. Among laparotomy patients, the rate of intraoperative blood transfusion was 5.9% (N = 120), reoperation for bleeding 0.3% (N = 5) and reoperation for hematoma 0.2% (N = 3). Conclusions: We found a low rate of VTE among patients undergoing laparotomy and MIS under an ERAS pathway. The rate of VTE following MIS surgery was low without use of extended pharmacologic VTE prophylaxis or receipt of preoperative prophylactic heparin. Receipt of preoperative heparin prophylaxis prior to open surgery is safe with a low complication rate. This establishes a benchmark for the expected rate of VTE following gynecologic surgery on an ERAS pathway.
Understanding mortality among hematology oncology patients identified from hospital administrative data.
Authors: Paracha Munizay , Parekh Anish , Sheikh Ayesha Rizwan , Nwabudike Stanley Madu , Fikre Tsion , Ko Naomi Yu 
Published: September 2021

215 Background: Hospital administrative data has large ramifications for quality of care and quality improvement projects. Unexpected inpatient mortality among patients with a hematology/oncology (H/O) diagnostic related group (DRG) is not widely studied and reported. We sought to investigate the unexpected inpatient mortality rate among cancer patients who were admitted to a large, urban, tertiary care safety net teaching hospital. Methods: We obtained the hospital’s adjusted mortality rate and evaluated the subset of specific observed/expected deaths ratio (O/E) of patients with a primary H/O diagnosis. We reviewed each case that was identified as an unexpected inpatient mortality from 2016 to 2018. A chart abstraction tool was designed for data abstraction that included demographics, location of admission, comorbid conditions, if mortality was expected, if documentation was reflective of the severity of the illness. Two independent reviewers abstracted each chart. A third reviewer assessed each case to make a final determination regarding expected mortality based on medical complexity and if documentation was reflective of severity of illness. Results: On review of the inpatient mortality data, the O/E for the H/O diagnostic related group (DRG) from Vizient was 1.14. Twenty two cases were identified as having an unexpected death. Among those cases, 23% of patients were transferred from an outside hospital, and 23% of patients did not have a known cancer diagnosis on admission. In the majority of cases, initial documentation did not accurately reflect severity of illness and/or specialists in hematology or oncology were not consulted at time of diagnosis. We noted the majority of patients were not followed by a hematologist/oncologist within the hospital system (63.6%). In 55% of patients, the cause of death was acute respiratory failure, and 14% of patients had an Advance Directive/DNAR in the chart prior to admission. Delayed antibiotics in febrile neutropenia and a missed blood transfusion reaction were among causes of unexpected deaths. Conclusions: Hospital generated data reported that mortality among H/O patients was greater than projected, however careful chart review of each case demonstrated a significant number of cases that were expected but the severity of illness was not documented properly to account for the death. Templates for proper documentation using the Vizient mortality variables is a key area to lower unexpected inpatient mortality.
Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.
Authors: Hoffmann Marc Steven , Neiberger Adam , Solis Gloria , Johnson Marshall , Fernandez Debbie 
Published: September 2021

218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.
Response-guided treatment optimization in the I-SPY2 trial.
Authors: Olunuga Ebunoluwa , Gibbs Jessica E. , Li Wen , Venters Sara , Delson Amy , DeMichele Angela , Isaacs Claudine , Hylton Nola M. , Rocque Gabrielle Betty , Esserman Laura 
Published: September 2021

222 Background: As new tools for prognostic prediction and assessment of treatment response in breast cancer are developed, there is growing interest in treatment optimization strategies to reduce toxic therapy or add additional therapy as needed. The I-SPY 2 trial utilizes a new predictive tool “PreRCB,” which includes mid-treatment MRI and core biopsy responses, to identify patients likely to have a pCR (pathologic complete response) who can de-implement, or forgo, standard-of-care anthracycline-based chemotherapy (AC) after treatment with a taxane + investigational agent. This study assesses initial de-implementation eligibility and selection within the I-SPY2 trial. Methods: All patients enrolled in I-SPY2 since September of 2020 (when the preRCB protocol was first introduced to the trial) who completed the first treatment regimen were evaluated. Patients were only considered for de-implementation of AC if the mid-treatment biopsy was routed to site clinical pathology for review for residual invasive disease. In these patients, preRCB was determined to be predictive of pCR if there was 1) no invasive cancer on the core biopsy and 2) MRI findings met subtype-specific functional tumor volume criteria. Patients meeting criteria for predicted pCR could be offered the option to go directly to surgery by their provider, foregoing pre-operative AC, with the option to receive AC post-operatively should the surgical specimen reveal residual disease. The following outcomes (n,%) were descriptively evaluated: patients participating in I-SPY2, sites with at least one patient evaluated for de-implementation using pre-RCB, patients eligible for de-implementation, patients with surgical RCB assessment, and patients who de-implemented chemotherapy. Results: From September 2020 – May 2021, 145 patients were eligible for analysis. 9/20 (45%) sites with eligible I-SPY patients had at least one patient considered for preRCB assessment. Only 46 patients (32%) had clinical reads on their biopsies, as required for preRCB evaluation. Of these, 48% (14/29) of patients met both MRI and pathology criteria to de-implement AC. However, only seven (50%) of these patients chose to proceed to surgery without preoperative AC. Of those who did not have a predicted pCR using preRBC criteria, 87.5% (28/32) received AC as recommended by the protocol and 12.5% (4/32) did not receive preoperative AC. Conclusions: These pilot results demonstrate slow uptake of this strategy by patients and clinicians. We are currently interviewing patients and physicians to identify and assess facilitators and barriers for patients and physicians to pursue response-guided treatment regimes. Understanding these motivations will create the opportunity to engage site, providers, and patients to engage in research optimizing chemotherapy treatment. Clinical trial information: NCT01042379.
Risk factors for ED visits and admissions during outpatient chemotherapy in head and neck cancer.
Authors: Shukla Navika , Saraswathula Anirudh , Khan Saad A. , Divi Vasu 
Published: September 2021

223 Background: Despite the recent introduction of the CMS metric, OP-35, which tracks 30-day inpatient admissions and ED visits after outpatient chemotherapy administration, the risk factors driving acute care utilization (ACU) in the head and neck cancer treatment setting are not yet well understood. Further characterization of these risk factors could allow for improved care quality and reduce preventable inpatient and ED admissions. Methods: This was a retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked cancer registry-claims database. The study cohort consisted of patients aged 66 years or older diagnosed with head and neck cancer between 2004-2015 who received outpatient chemotherapy within the first two years after diagnosis. Multivariable logistic regression modeling was utilized to characterize the risk factors associated with an inpatient or ED admission within 30 days after receiving chemotherapy. Results: Of the 2,236 eligible patients, 735 (32.9%) had at least one inpatient or ED admission within 30 days of receiving outpatient chemotherapy. On multivariable analysis, cancer of the oral cavity [odds ratio (OR) 1.43; 95% confidence interval (CI) 1.04-1.96] and oropharynx/hypopharynx [OR 1.34; 95% CI 1.06-1.70] were associated with an increased odds of ACU. Other factors associated with ACU included NCI comorbidity index [OR 1.10; 95% CI 1.03-1.18], prior ACU [OR 1.06; 95% CI 1.02-1.09], second cycle of chemotherapy relative to the first cycle [OR 0.38, 95% CI 0.29-0.50], and third or greater cycle of chemotherapy [OR 0.17; 95% CI 0.13-0.21]. Certain chemotherapeutic agents also modified risk: use of an angiogenesis inhibitor [OR 0.18; 95% CI 0.06-0.45], alkylating agent [OR 1.24; 95% 1.01-1.53], plant alkaloid [OR 1.63; 95% CI 1.25-2.10], or antimetabolite [OR 2.69; 95% CI 1.78-4.09]. The most common admission diagnosis was pain (n = 243; 33.1%) followed by dehydration (n = 167; 22.7%). Conclusions: Multiple clinical variables modify risk of acute care utilization after outpatient chemotherapy in the head and neck cancer setting, providing several potential avenues of intervention for providers.
Decreasing inpatient chemotherapy initiation delays at Memorial Regional Hospital.
Authors: Vulfovich Michel , Salzberg Matthew Philip , Louis-Jeune Marie , Pham Khang , King Kelly , Jacques Jessica , Lanier Ulonda , Morris Amy 
Published: September 2021

225 Background: Between June and December 2019, hematology-oncology patients admitted for elective chemotherapy at Memorial Regional Hospital had a median delay of 10 hours to initiate chemotherapy infusion from time of admission. This contributes to increased cost to the healthcare system and patient dissatisfaction. By September 2020, elective inpatient median time from admission to chemotherapy initiation at Memorial Regional Hospital will be reduced by 20%. Methods: Multidisciplinary team formed to evaluate the time from admission to initiation of chemotherapy for patients who are electively admitted for chemotherapy in 8 Central based on time stamps available in the electronic health records. Patients electively admitted by a non MCI oncologist were excluded. Data collections included time stamp between each process from admission to administration of 1st chemotherapy. Longest time lapse between each process was counted as an occurrence/contributor to delay. Top 80% contributors identified from Pareto chart allowed team to identify countermeasures. Priority Matrix of implementation in PDSA cycle based on highest impact and ease of implementation. Statistical process control chart was developed. Results: (see table). Conclusions: PDSA Cycle 1, obtaining labs 24-48 hours prior to admission, resulted in a 10% reduction in chemotherapy initiation time. PDSA Cycle 2, enhancing “ok to treat” communication, resulted in a further reduction of time to treatment. The combination of PDSA Cycle 1 & 2 resulted in a 40% reduction in time to chemotherapy initiation, exceeding the planned aim of 20%. Balance measures reflected no reduction in the mean number of overnight stays between baseline and PDSA Cycle 2 (4 nights) that could contribute to a decreased cost. Results and recommendations to adopt at all inpatient oncology departments within the healthcare system will be presented to leadership for support. Data automation through collaborative efforts with information technology is in process to assist with continuous monitoring. Future state, the quality improvement tools gained from ASCO QTP will be utilized to evaluate and improve workflow issues in the outpatient oncology setting. Nationally recognized organizations are encouraged to propose a benchmark for admission time to first chemotherapy administration based on the evaluation of current available data. Additional studies are needed to evaluate chemotherapy treatment delays in other settings.[Table: see text]
Suboptimal clinician awareness of appropriate NTRK fusion testing and TRK inhibitor use in solid tumors.
Authors: Topping Ryan P. , Marcello Krista , Fagan Terrence , Quill Timothy A. , Bauer Todd Michael , Drilon Alexander E. , Demetri George D. 
Published: September 2021

229 Background: Since late 2018, 2 TRK inhibitors—larotrectinib and entrectinib—have been approved by the EMA and FDA for treating patients with advanced solid tumors harboring an NTRK fusion and progressive disease or no therapeutic alternatives. It is recommended that testing for NTRK fusions occur as early as possible after a diagnosis of advanced disease in patients with solid tumors to inform potential use of TRK inhibitors. Methods: Between April 2018 and April 2021, we conducted multiple live and online educational activities for oncology healthcare professionals (HCPs) on NTRK fusion testing and/or TRK inhibitor treatment for varied solid tumors. Each activity included polling questions designed to assess HCP knowledge and practice patterns. In this analysis, we assessed HCP responses to these questions to evaluate awareness of expert recommendations on NTRK fusion testing and the selection of TRK inhibitor therapy for appropriate patients. Results: In 6 live and online activities with data from April 2018 to April 2021, 29% of HCPs (n = 844) indicated that they ordered molecular profiling to test for NTRK fusions in all solid tumors in their current practice. Of note, low rates of testing were reported in TRK inhibitor/ NTRK testing-focused activities throughout this time period, with no significant increase over time. In assessing different patient cases across 8 activities where experts recommended TRK inhibitor therapy as optimal, many HCPs did not select a TRK inhibitor, with considerable variance by tumor type (Table). *For all cases, experts selected larotrectinib and/or entrectinib as optimal treatment. †HCP respondents. GBM, glioblastoma; GI, gastrointestinal; MSI-H, microsatellite instability-high; PD, progressive disease; PTC, papillary thyroid cancer.Conclusions: The rate of broad testing for NTRK fusions across patients with solid tumors remains low, and many HCPs lack awareness of when to consider a TRK inhibitor. Educational activities designed to address these deficiencies would be of clear benefit to HCPs treating patients with advanced solid tumors. A detailed analysis of HCP trends will be presented.[Table: see text]