bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving management of hypersensitivity reactions: A BC Cancer-Victoria quality improvement initiative.
Authors: Rauw Jennifer Marie , Parimi Sunil , Anderson Helen , Hinada Pamela , Abrahams Bethina , Hennessy Katie 
Published: September 2021

230 Background: Hypersensitivity reactions (HSR) are a documented, predictable side effect of multiple chemotherapy agents. Reactions negatively affect the patient experience, increase the amount of chair time, nursing and physician resources, may result in the omission of a potentially effective cancer management tool from a patient’s treatment plan and could potentially result in death. BC Cancer is a Health Care Organization with 6 cancer centres across British Columbia, Canada. Guideline(GL)s have been developed at BC Cancer to support clinicians to manage reactions acutely and reduce the risk of reactions with subsequent cycles. A recent audit identified that the GLs were not always being followed at the Victoria Centre. Our goal was to encourage physician and nursing staff to follow GLs, which we hypothesized would result in decreased rates of HSR. Methods: Our aim was to decrease HSR to < 5% of doses delivered within 1 year at BC Cancer-Victoria. We engaged stakeholders (nursing, physicians, pharmacy, clerical staff and administration). Our change ideas improved adherence to GLs by focusing on: physician attendance and documentation, written orders for rescue medication, and rate of infusion of the chemotherapy drug rechallenge. Our interventions included: two physician-education sessions, one nursing education session, daily huddles, pre-printed order development for management of the reaction (PPOA) and prophylaxis for subsequent cycles (PPOB), and a modified clinic flow. All interventions were introduced and underwent modifications through PDSA cycles. Our family of measures were: Outcome: number of reactions, percent of reactions per dose given. Process: percent of PPO use per reaction, physician attendance and notes dictated per reaction. Balancing: physician and nursing satisfaction. We analyzed the data using quality improvement run charts and control charts. Results: After the start of our initiative, our total number of reactions displayed special cause variation, and a shift in the baseline from a mean of 11.27 HSR per month to 7.526. This change was reflected in the percentage of reactions per doses given which fell from 3.1% to 1.9%. Average percentage of dictated notes per reaction increased from 55% to 64%. Physician attendance per reaction also showed special cause variation with the average increasing from 57% to 90%. PPOA and PPOB use both increased over time. Nursing and Physician satisfaction data will also be presented. Conclusions: Our successful initiative has resulted in HSR management which more closely reflects GLs, including increased physician attendance and notes, and clear consistent written orders detailed on PPO A and B. This has led to decreased HSRs at our site, resulting in decreased resource use and increased patient safety and quality. This has provincial implications as there is the potential to spread this initiative to other BC Cancer sites.
Improving the completion rate of outpatient stool-based colon cancer screening during a global pandemic.
Authors: Aung Ye , Scherer Christian , Gdowski Andrew , Cubas Doris , Horton Alexandra , Saghir Nabeel , Sadler Holli 
Published: September 2021

238 Background: Colon Cancer Screening is an important intervention to reduce the morbidity and mortality of colorectal cancer. In particular, stool based screening tests help to increase the availability of screening especially amidst a global pandemic. However stool based screening is limited by patient return rates of FIT/iFOBT tests. Here at the Austin Outpatient VA we sought to improve the FIT test return rate of patients in our resident clinic by at least 20%. Methods: We did a root cause analysis as to why iFOBT/FIT were not being returned, particularly during the height of the pandemic when most visits were virtual. With help from the VA data core we generated a list of 76 patients during a period from 2/3/2020-7/7/2020 who had not returned an ordered FIT/iFOBT test in >30 days. We called these patients to identify the reasons why they did not return their test. Results: We were able to reach (44/76) patients and discovered that only (12/44) 27.3% of patients contacted had received a FIT test. Of our patients-reached 33/44 of them asked for a new FIT test to be sent to them and ultimately (21/44) patients contacted returned and completed their FIT test successfully with 3 tests being positive and referred to diagnostic colonoscopy. This resulted in an improvement in return rate of ̃47% of all patients ultimately contacted. Conclusions: Through a meeting of stakeholders including nurses and resident physicians we discovered in our EMR, that the order to send out a FIT test does not automatically alert a nurse nor does it automatically mail out or send out a FIT test. We discovered there was not a standardized process in place to facilitate communication between physicians ordering tests and nurses, thus FIT/FOBT tests were not being sent. We are currently working on a process to standardize the FIT test ordering process to improve communication between physicians and nurses. We are developing a better order set that reminds providers to alert and message nurses prior to ordering the FIT/iFOBT test. We are also educating Residents about the FIT/FOBT ordering process. With future PDSA cycles we should be able to improve the robustness and reliability of our outpatient colon cancer screening process through improved inter-professional communication.
Analysis of reasons for Emergency Department (ED) visits and subsequent hospital admissions in patients with solid malignancies: A retrospective study from a cancer center in rural Maine.
Authors: Patwari Anannya , Bhatlapenumarthi Vineel , Brann Courtney , Waldrip Jackson , Caruso Victoria , Hatch Abigail , Curtis Adam , Chodkiewicz Catherine 
Published: September 2021

241 Background: Reducing ED visits in patients with cancer is cost saving and is particularly relevant during the COVID pandemic. We aim to identify patterns of ED visits among various cancer patients and reduce preventable ED visits and hospital admissions. Methods: We analyzed the number of ED visits and hospital admissions that occurred in patients with breast, lung, and Gastrointestinal (GI) cancers between July12019 and October31 2020 including demographics, stage, treatment type preceding the month of ED visit, reason, time of the day, day of the week the visit occurred. Results: 308 patients had 519 ED visits, 111 breast cancer patients had 184, 102 lung cancer patients had 186 and 95 GI cancer patients had 149 ED visits. 38% had > 1 visit. 51%, (37% breast, 60% Lung and 58 % GI cancer) had stage 4 disease at the time of visit. There were no visits in the month of May 2020. 275 (53%) visits required hospital admissions, 60% of ED visits in lung cancer, 54% in GI and 46 % in breast cancer patients required hospitalization. Most common reason for ED visits in breast cancer patients was fall/injury (20%), with median age of 71 years, none were cancer/ chemotherapy induced. Among lung and GI cancer patients respiratory (24%) and GI related (24%) symptoms were the most common reasons respectively, majority were cancer/chemotherapy related. Most common symptoms requiring hospital admissions were respiratory 21%, GI 18%, cardiac 12%. 11% and 9% of ED visits were due to fall/injury and cancer related pain, of these 3.6% and 9% resulted in hospital admissions respectively. Lung and GI cancer patients were more likely to be referred to the ED from the oncologist office (23%) than breast cancer patients (11%). Conclusions: Reasons for ED visits vary by tumor types and some may be preventable. Fall/injury in breast cancer patients and cancer related pain in lung and GI cancer patients were frequent reasons for preventable ED visits. In lung and GI cancer patients, cancer/chemotherapy related respiratory, GI symptoms are felt to be less avoidable since they may be related to disease progression or presenting symptoms. We have initiated several strategies such as ‘’systematic physical therapy assessment’’ of our breast cancer patients over age 70 to reduce ED visits due to fall/injury. We are developing strategies to involve palliative care early to reduce the number of ED visits related to cancer related pain We now have “call us first campaign” to assess and intervene before going to ED since most visits occurred during working hours.[Table: see text]
Variable implementation of optimal therapeutic strategies in metastatic colorectal cancer: Reviewing rates of liver resection and triplet chemotherapy across Australian hospitals as potential quality indicators.
Authors: Dunn Catherine , Gately Lucy , Tie Jeanne , Nott Louise M. , Lee Belinda , Mendis Shehara Ramyalini , Shapiro Jeremy David , Wong Vanessa , Burge Matthew E. , Wong Rachel , Kosmider Suzanne , Lee Margaret , Jennens Ross , Gibbs Peter 
Published: September 2021

248 Background: Quality indicators (QI) are essential to monitor the efficacy of cancer care and to guide quality improvement, however many are derived from ‘expert consensus’ and are not validated against outcomes. Moreover, the majority of oncological QI are defined in the surgical setting, with only a paucity of QI for the treatment of metastatic disease. We aimed to define and validate novel QI for metastatic colorectal cancer (mCRC) based on therapeutic approaches associated with a proven survival benefit. Methods: Data was analysed from TRACC, a multisite Australian registry collecting prospective demographic, tumour, treatment and outcome data for mCRC. We identified all patients diagnosed across 11 hospitals and explored variation by site with regards to patient and tumour characteristics, first-line chemotherapy administration and resection of oligometastatic disease. Log-rank testing and Kaplan-Meier curves compare overall survival (OS) between sites, and Pearson correlation was used to assess associations with each QI. Results: We examined data from 3132 patients diagnosed with mCRC between July 2009 – April 2021. Median age was 66 years (range 62 – 71 years by site), ECOG 0-1 81% (range 69 – 96% by site), and Charlson Comorbidity Index ≤2 43% (33 – 59% by site). Multivariate analysis confirmed association of known adverse prognostic factors with inferior OS (poor ECOG, right sided primary, KRAS or BRAF mutation, all p <0.05). Median OS for entire cohort was 26.2 months (95%CI 24.9 – 27.3 months), and varied by hospital site from 20.1 – 36.1 months (p<0.001). Of the QI evaluated, rate of triplet chemotherapy (FOLFOXIRI) administration (2.8 – 13.2% by site) was very strongly correlated with OS (R2 = 0.851), rate of liver resection (9.8 – 23.2% by site) was moderately correlated (R2 = 0.523), and rates of active treatment with first-line chemotherapy (63 - 90% by site) were weakly correlated (R2 = 0.209). Other proposed QI such as rates of lung metastases resection or chemotherapy administration in the elderly showed significant variation by site, but did not correlate with survival. Conclusions: There is significant variation in OS for patients with mCRC in these Australian hospitals, with major differences in treatment approaches. Treatment strategies known to improve survival outcomes, such as triplet FOLFOXIRI chemotherapy and resection of liver metastases, may be potential QI to benchmark and track quality improvement over time. Further analysis will determine the impact of baseline patient populations between sites, and to correlate these QI with other quality measures.
Hematology/oncology utilization of advance care planning services.
Authors: Dickson Natalie R. , Hirschorn Allison , Bourbeau Brian , Thomas Christian A. , Thebarge Stephanie , Srivastava Piyush , Soliman Pamela T. , Levanduski Heather 
Published: September 2021

25 Background: In 2016, Medicare added coverage for advance care planning (ACP) services (CPT codes 99497 and 99498). ASCO’s Coverage and Reimbursement Steering Group sought to explore and quantify whether these codes are regularly utilized by hematology and oncology physicians, and to provide guidance on administrative best practices for successful reimbursement. Methods: We analyzed utilization of care management services using Physician/Supplier Procedure Summary (2016-2019) and Medicare Provider Utilization and Payment Data: Physician and other Supplier PUF CY2018 (PUF) files, available on data.cms.gov. Data files are limited to lines representing services to at least 11 unique Medicare beneficiaries; otherwise, Medicare imputes a blank value. Total ACP services submitted to Medicare and the total services denied were calculated for each year using the combination of Hematology, Hematology/Oncology, and Medical Oncology (collectively Hematology/Oncology) specialties, as well as for all specialties. Within Hematology/Oncology, we also pulled physician-level data for 6,335 physicians who had billed Medicare for at least 500 office or hospital outpatient evaluation and management services in 2018. Totals for codes 99497 and 99498 were calculated per physician, providing a distribution of volume. Results: Specialty utilization of ACP services has increased each year, from 708,183 submitted services in 2016 to 2,043,767 in 2019. Hematology/Oncology utilization increased from 2016 to 2017, followed by declines in volume for 2018 and 2019. Among 6,355 hematology/oncology physicians submitting at least 500 office or hospital outpatient evaluation and management visits, 145 billed Medicare at least 11 ACP services in either a facility or non-facility setting. Advance Care Planning Services (99497 and 99498) billed to Medicare in 2016-2019. Conclusions: Though Advance Care Planning is an integral part of cancer care, the codes are not frequently reported to Medicare as a separate service. This may be due to lack of awareness or understanding of the codes, and uncertainty as to how to implement the services into the workflow of the practice. To increase utilization and ensure appropriate reporting of ACP, Oncologists and Oncology practices would benefit from coding and reporting education, and well as guidance on administrative processes to successfully manage ACP services. ASCO's Coverage and Reimbursement Steering Group has developed a practice administration and reimbursement guide for publication on asco.org.[Table: see text]
Oncology rapid assessment clinic and effect on ED visits.
Authors: Dreyer Marie S. , Paschall Marcus , Karrison Theodore , Polite Blase N. 
Published: September 2021

258 Background: The use of the Emergency Department (ED) by oncology patients for lower acuity issues is common. Oncology Rapid Assessment Clinics (ORAC) may play a key role in reducing ED visits among oncology patients. We analyzed whether the advent of ORAC was associated with lower ED utilization by patients receiving cancer care at University of Chicago Medical Center (UCMC). Methods: UCMC opened its ORAC in March 2019 to provide supportive care and symptom management to cancer patients who needed acute medical issues addressed. To identify active cancer patients, we identified those that had either a forward or reverse 9 month rolling count of greater than or equal to 2 Outpatient Clinic Visits (complete or future). Of all those patients, we identified any ED visit made within the time period considered Pre-ORAC (6/2018-2/2019) and Post-ORAC (6/2019-2/2020). To determine effect of ORAC on ED utilization, we performed t-test comparison of rates. Results: A total of 9,043 unique patients were seen in the Pre-ORAC period and 8,753 in the Post-ORAC period. Predominant cancers seen in both periods were Breast, Lung/Head & Neck, GI, Lymphoma/Leukemia, GU, and Multiple Myeloma. The ED visit rate was 0.252 (2279/9043) in Pre-ORAC period and 0.237 (2075/8753) in the Post-ORAC period (p = 0.02). Conclusions: There was a decrease in ED visit rates for oncology patients cared for by UCMC in the immediate period after the opening of the ORAC clinic. More substantial declines are expected in the future as the capacity and efficiency of the ORAC clinic grows and the concept is socialized among cancer providers.
System-wide depression screening implementation in ambulatory oncology care: Key strategies and early implementation outcomes.
Authors: Huang Chao-Hui , Ryans Ehimwenma Judith , Otuada Mayowa , Allen Laquetta F , Taylor Richard A. , Rocque Gabrielle Betty 
Published: September 2021

260 Background: Oncology Care Model (OCM) requires cancer programs to provide depression screening during each care episode to meet the quality measure benchmark of 85% screening rate. This quality improvement (QI) project aims to assess 1) key strategies to integrate system-wide depression screening into routine cancer care, and 2) early outcomes of depression screening implementation. Methods: A mixed-method study design was used to assess strategies to implement routine depression screening in a southeast comprehensive cancer center between July 2019 and December 2020. Two top high-volume hematological oncology clinics that covers sixty percent of ambulatory care participated in the depression screening implementation. Data were collected using 1) depression screening completion rate during OCM performance periods, 2) needs assessment to identify barriers and facilitators of implementation, and 3) semi-structured interviews to assess staff and provider feedback on sustainable implementation strategies. Data were analyzed using descriptive analysis for quantitative outcomes and thematic analysis for qualitative outcomes. Results: A total of 64 hematological oncology providers (n = 22) and staff (n = 42) participated in the depression screening implementation training during three OCM performance periods. Depression screening rate of total ambulatory oncology care increased from 12% (OCM-PR 5, Jul-Dec 19), to 51% (OCM-PR 6, Jan-Jun 20) to 77% (OCM-PR 7, Jul-Dec 20) after the two top-volume clinics integrated depression screening into clinic intake process. Themes emerged from needs assessment revealed multi-level implementation strategies including 1) patient education and psycho-oncological care, 2) staff training and practice modification, 3) provider education & interdisciplinary Care, 4) leadership, administration, and staffing support, and 5) clinical informatics collaboration to build the infrastructure for integrating depression screen with clinic intake in the electronic medical record (EMR). Feedback from staff and provider interviews indicated high receptiveness and buy-in, especially during the COVID-19 pandemic to improve timely identification and triage of patients with depressive symptoms across all oncology care services. Conclusions: Depression screening is a key component of quality comprehensive cancer care that aims to provide timely identification and triage of cancer patients needing follow-up psychosocial care. Early implementation outcomes revealed significant improvement in depression screening completion rate after two clinics adopted depression screening into intake process. Further investigation is needed to refine system-wide implementation strategies across all ambulatory oncology sites and to assess long-term implementation outcomes meet the psychosocial care needs of cancer patients.
Improving oral chemotherapy compliance and documentation in a safety-net oncology clinic.
Authors: Hester Robert Harrison , Farmer Lindsey Leigh , Goswamy Rohit Vivek , Chen Natalie , Lee Sophia Seo-hyeon , Sember Quinne , Khwaja Raamis , Dash Akshar , Nguyen Daniel , Haddad Christina S. , Wiele Andrew James , Ma Hilary Y. 
Published: September 2021

263 Background: Barriers to safe delivery of oral chemotherapy in a safety net hospital population include lack of health insurance, delays in medication delivery, and language barriers. Baseline chart review at the Lyndon B. Johnson Hospital oncology clinic revealed sparse documentation of oral chemotherapy education and compliance. Our team conducted the present quality improvement project to improve documentation of toxicity assessment, patient education, and compliance with the oral chemotherapy agents capecitabine, palbociclib, and sorafenib by 25% from October through December 2020. Methods: A set of standardized questions designed to assess for the above domains were generated in the form of an auto-populated electronic medical record phrase ("dot phrase," see Figure 1). Using weekly timed email notifications, physicians were reminded to incorporate these questions in their documentation during clinic visits. Chart review was performed to assess usage frequency of the dot phrase. A post-intervention survey was administered to assess providers' experience with use of the dot phrase, and assess barriers to consistent documentation. Results: 41 patients over 3 months were identified as taking the oral chemotherapy drugs capecitabine (68%), palbociclib (29%) or sorafenib (3%). 63% were non-English speakers. 49% had breast cancer, 39% GI cancers, and 12% other cancers. 12% of clinic visits correctly incorporated use of the dot phrase. Education on the dosing and schedule for oral chemo was addressed for 48% of patients, documentation of adverse effects was performed for 34% of patients, and assessment of medication adherence was documented for 22% of patients. While 73% of providers felt that documentation of oral chemotherapy compliance is important, 70% cited failure to remember to incorporate the dot phrase in real time as the primary reason for failure to use the dot phrase for oral chemotherapy documentation. Conclusions: Despite providers' view of documentation of oral chemotherapy toxicities and compliance as important, low uptake of the dot phrase was observed. The main barrier to use of the dot phrase was providers' forgetting to incorporate the dot phrase prior to and during their clinic charting. Future efforts should focus on automated reminders and regular assessments to increase compliance to this important quality domain. [Table: see text]