bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability of claims-based measures used to assess cancer care quality.
Authors: Urick Benjamin , Burbage Sabree , Baggett Christopher , Lafata Jennifer Elston , Sanoff Hanna Kelly , Trogdon Justin G. 
Published: September 2021

42 Background: As value-based payment models for cancer care expand, the need for measures which reliably assess the quality of care provided increases. This is especially true for models like the Oncology Care Model (OCM) that rely on quality rankings to determine potential shared savings. Under models like these, unreliable measures may result in arbitrary application of value-based payments. The goal of this project is to evaluate the extent to which measures used within the OCM are reliable indicators of provider performance. Methods: Data for this project came from North Carolina Medicare claims from 2015-2017. Episodes were attributed to physician practices at the tax identification number (TIN) level, lasted 6 months, and were divided into two performance years beginning 1/1/2016 and 7/1/2016. TINs with fewer than 20 attributed patients were excluded. Three claims-based OCM measures were used in this evaluation: 1) proportion of episodes with all-cause hospital admissions; 2) proportion of episodes with all-cause emergency department (ED) visits or observation stays; and 3) proportion of patients that died who were admitted to hospice for 3 days or more. Risk adjustment followed the method described by measure specifications from the OCM. Reliability was calculated as the ratio of between practice variation (e.g. signal) to the sum of between practice variation and within practice variation (e.g. noise). Variance estimates were derived from hierarchical logistic regression models used for risk adjustment. Results: For the hospitalization and ED visit measures, episode counts for years 1 and 2 were 30,746 and 28,430 and TIN counts were 86 and 84, respectively. Hospice use measures had fewer episodes (2,677 and 2,428) and TINs (36 and 33). Across all measures, median reliability scores failed to achieve the recommended 0.7 threshold and only hospice had a median reliability score above 0.5 (Table). Conclusions: These findings suggest claims-based measures included in the OCM may produce imprecise estimates of provider performance and are vulnerable to random variation. Consideration should be given to developing alternative measures which may be more reliable estimates of provider performance and to increasing minimum denominator requirements for existing measures.[Table: see text]
Associations between costs of oral hormonal therapies for prostate cancer, financial assistance mechanisms, and time on treatment.
Authors: Schwartz Eric B , Jeong Angelina , Roman Andrea , McDevitt Rachel , Henry Elyssa , Veenstra Christine M. , Caram Megan Veresh 
Published: September 2021

61 Background: Numerous oral anticancer drugs approved for metastatic prostate cancer are expensive and put patients at risk for financial toxicity. Mechanisms to mitigate these costs are complex to navigate and are variable for different patient populations. We examined the impact of high costs and insurance type on time on therapy and reason for discontinuation of oral medication in patients with prostate cancer. Methods: We identified patients with prostate cancer who filled prescriptions for abiraterone or enzalutamide at our comprehensive cancer center 1/1/17-3/31/19, or who were prescribed one of these therapies but could not fill due to cost. Those with commercial insurance or Medicare part D were included. Clinical and demographic data was extracted for evaluation. Primary outcome variables included initial out-of-pocket cost, time on treatment, and failure to fill medication due to cost. Analysis using chi squared, T-tests and ANOVA was performed to assess associations. Results: We identified 193 patients. Of these, 34% had commercial insurance and 66% had Medicare part D. Mean out-of-pocket expense for the first fill was $62 for patients with commercial insurance and $582 for patients with Medicare Part D. Among those who did not fill due to cost, 9 had Medicare Part D and 1 had commercial insurance. The mean time on therapy for those with commercial insurance was 452 days vs 442 days for those with Medicare Part D. At time of data analysis, 50% of those with commercial insurance vs 45% of those with Medicare Part D remained on treatment. Of those who discontinued, 50% of those with commercial insurance did so due to progression or death vs 44% with Medicare part D. 14% with commercial insurance and 15% with Medicare part D discontinued to due patient preference or toxicities. 1 patient with Medicare part D and no patients with commercial insurance discontinued due to cost. There was no difference in time on therapy by out-of-pocket expense (average 444 days for out-of-pocket < $100 vs 477 days for out-of pocket > $100; p = 0.6) although those with an initial out of pocket expense > $100 were more likely not to fill their medication (24% vs 1%, p < 0.01). Conclusions: Costs remain high for oral prostate cancer treatments. Our findings suggest disproportionate financial burden among patients with Medicare Part D causing a significant number of patients to forego recommended therapy. While high costs did lead to failure to fill, we did not observe significant differences in time on treatment for patients with Medicare part D or with high out-of-pocket expense. Additionally, there was not a significant difference in stated reason for stopping therapy. Further research on patient perceptions of financial assistance programs and medication costs are planned.
Biosimilar uptake of filgrastim and impact on spending in Medicare Part D from 2015 to 2019.
Authors: Hussaini Syed , Gupta Arjun , Anderson Kelly E. , Ballreich Jeromie M. , Nicholas Lauren H. , Alexander Caleb 
Published: September 2021

67 Background: The introduction of a filgrastim biosimilar in 2014 was associated with substantial cost savings in Medicare Part B and Medicaid programs. However, Medicare Part D is unique since it is unable to directly negotiate prices with drug manufacturers. We sought to investigate the uptake of filgrastim biosimilars and impact on spending among Part D beneficiaries. Methods: We evaluated utilization trends for filgrastim (Neupogen), filgrastim-sndz (Zarxio), and tbo-filgrastim (Granix) using the 2015-2019 Medicare Part D Prescription Drug Event data. We conducted a retrospective cross-sectional review of annual spending, number of beneficiaries, number of claims, spending per beneficiary, and spending per dosage unit. We excluded filgrastim-aafi (Nivestym) due to recent approval and adjusted for inflation using 2019 dollars. Results: In 2019, total aggregate Part D spending on filgrastim products was $78 million. From 2015 to 2019, the biosimilar share of total aggregate spending increased from $1.8 million (2%) to $44 million (56%), with combined biosimilar spending (Zarxio and Granix) eclipsing originator Neupogen in 2018 (within 4 years of FDA approval of Zarxio). Total spending on Neupogen reduced 58% from 2015 to 2019. While biosimilar uptake progressively increased every year, total aggregate spending on all filgrastim forms reduced only 7% from 2015 to 2019 ($84 million to $78 million). For all 3 forms, from 2015 to 2019, trends in spending were: average spending per claim ($3193 to $2549, -20%), average spending per beneficiary ($5880 to $6722, +15%), and average spending per dosage unit of filgrastim ($583 vs $571, -2%). Detailed results in Table. Conclusions: We demonstrate that the significant uptake of biosimilar filgrastim products in Medicare Part D from 2015 to 2019 was associated with a small decrease in aggregate spending, essentially unchanged per unit spending, and increased spending per beneficiary on filgrastim products. Our findings contrast with experiences across Medicare Part B and Medicaid, that demonstrated significant cost savings with biosimilar filgrastim uptake. This may be due to inability of Medicare Part D to directly negotiate prices with manufacturers (in contrast to Medicare Part B and Medicaid), supporting ongoing Congressional policy being debated in the United States Senate (H.R. 3).[Table: see text]
Oncology value based payment models: Where are the savings opportunities?
Authors: Oh Era Kim , Maguire Jon , Spinks Tracy E. , McNiff Landrum Kristen K. , Malin Jennifer 
Published: September 2021

69 Background: Oncology practices are increasingly participating in value-based payment (VBP) arrangements; however, there is limited information on where practices have the greatest impact on reducing medical costs. Methods: United Healthcare (UHC) conducted a pilot to evaluate a VBP consisting of an episode fee, eliminating drug margin, and shared savings. The pilot was limited to members with breast, lung or colon cancer enrolled in UHC’s commercial plans. We compared total medical cost (TMC) per 120-day episode calculated from paid claims amounts for the pilot practices with a concurrent national cohort for the performance period (9/2015-9/2019) and a baseline period (1/2013-3/2015) using a difference-in-differences technique with a generalized linear regression model, adjusting for age, gender, cancer type and stage (adjuvant vs. metastatic), comorbidities, cancer surgery, radiation therapy, novel therapy, duration of therapy, and region. We categorized claims into 6 categories and estimated the impact of the VBP on costs: chemotherapy/drugs, radiation therapy, cancer surgery, cancer diagnostics, other cancer-related and other non-cancer related. In addition, we evaluated the difference in acute inpatient admission rates. Results: Patient treated in the pilot practices contributed 2,647 episodes of a total of 73,352 episode during the performance period, weighted equally between adjuvant and metastatic disease (Table). The adjusted TMC per 120-day episode was $36,434 for the national cohort and $37,215 for the participating clinics at baseline and $50,773 and $41,416, respectively during the performance period, resulting in an average decrease in TMC of $9,687 or a 20% reduction; although this varied significantly by stage and cancer type. The relative decrease in medical costs by category ranged from 13% for chemotherapy/drugs to 33% for cancer surgery and an increase in costs associated with cancer diagnostics of 7%; however, chemotherapy/drug were still associated with the largest absolute decrease in costs ($2,941). Practices participating in the pilot had a 24.7% decrease in the number of acute inpatient admissions and 12.6% decrease in the number of inpatient admission days; however, this did not reach statistical significance. Conclusions: Overall, practices participating in a VBP pilot with a commercial health plan decreased TMC per episode by 20% with savings across all cost categories except for cancer diagnostics.[Table: see text]
Association of Medicaid expansion under the Affordable Care Act and early mortality following lung cancer surgery.
Authors: Nogueira Leticia , Jemal Ahmedin , Han Xuesong , Yabroff K. Robin 
Published: September 2021

76 Background: Medicaid expansion under the Affordable Care Act is associated with gains in health insurance coverage and a shift towards earlier stage diagnosis among patients with cancer. However, the association between Medicaid expansion and cancer mortality has not been well characterized. The aim of this study was to evaluate the association of Medicaid expansion with changes in early mortality, defined as death within 30 days after major NSCLC surgery, among adults discharged following major surgery for non-small cell lung cancer (NSCLC), a setting where access to care is a major determinant of death. Methods: Of the 11,627 patients selected from the National Cancer Database who were aged 45-64 (more likely to be diagnosed and die from NSCLC and not age-eligible for Medicare coverage) and were discharged from the hospital following major surgery for treatment of NSCLC between 2009 and 2018, 7,294 patients lived in expansion states and 4,333 lived in non-expansion states. Differences-in-differences (DD) analyses were used to evaluate the impact of Medicaid expansion on early mortality pre-(2009- 2013) and post-ACA (2014- 2018). Results: Early mortality among patients discharged from the hospital following NSCLC surgery statistically significantly decreased from 2.4% pre-ACA to 0.8% post-ACA among patients in Medicaid expansion states (1.6 percentage point decrease, p <.0001), but not in patients living in non-expansion states (from 2.1% to 1.6%, p = 0.2), leading to a DD of 1.1 percentage points (95% Confidence Interval = 0.1, 2.1; p = 0.03). Conclusions: This study found a decrease in early mortality following hospital discharge after NSCLC surgery post-ACA among patients living in Medicaid expansion states and no change in patients residing in non-expansion states. Medicaid expansion may be an effective strategy for improving access to care and cancer outcomes among older adults who are not age-eligible for Medicare.
Receptiveness and barriers to clinical trial participation for oncology patients from a public safety-net hospital.
Authors: Chiu Victor Yundeh , Berkowitz Jacob S. , Rodriguez Joshua , Law Jade , Lee Kristina , Torres Joe , Attai Deanna J. , Berkowitz Maurice J. 
Published: September 2021

83 Background: Oncologic clinical trial enrollment is low, particularly in underserved populations. Increasing enrollment of public safety-net hospital patients is important to ensure representation of the general population and reduces cancer outcome disparities. To tailor clinical trial outreach, we sought to characterize attitudes towards trial participation of oncology patients at Olive View—UCLA Medical Center (OVMC), a public safety-net hospital in Los Angeles County. Methods: We developed a 39-question survey (Qualtrics, Provo, UT). It was administered via tablets to a convenience sample of patients in OVMC’s medical oncology clinic and infusion center during 2020—2021. The survey was offered to patients fluent in English or Spanish. Results: Of 165 patients who were offered the survey, 11 declined due to illiteracy in any language, 4 did not finish the survey. Median age was 54 (range: 20-81); 63% were female. The majority (76%) reported an annual income below $25,000; 39% did not complete high school. Self-identified ethnicity was Hispanic/Latino (73%), non-Hispanic White (12%), Asian-Pacific Islander (9%), and Black (4%). Based on a 5-point Likert scale of comfort speaking English, 48% had English proficiency (EP). Overall, 69% of patients expressed interest in trials. When considering participation, patients would seek advice from their physician (86%), family (32%), other medical staff (14%), alternative medicine practitioner (7%), friend (6%), or religious leader (4%). Concerns regarding trial participation were lack of knowledge regarding trials (47%), fear of side effects (43%), frequent visits (25%), cost (20%), transportation (14%), wage loss (9%), and inability to determine own treatment (4%). Patients found the following modalities useful for learning about trials: website (43%), paper handout (39%), video (37%), discussion with prior participants (34%). Patients with annual income > $25,000 were significantly more concerned about cost (33.3% v. 15.8%, p = 0.04) and treatment side effects (61.1% v. 36.8%, p = 0.02). EP patients were more likely to find a website (54.2% vs. 32.1%, p = 0.01) or discussion with prior participants (45.8% v. 23.1%, p < 0.01) helpful compared to low EP patients. Conclusions: There is considerable interest in oncologic clinical trials in this predominantly Hispanic/Latino population. This population had significant trust in physicians for guidance on trial enrollment, and had minimal concern for out-of-pocket cost, wage loss, or transportation issues. The majority of patients did not find additional informational resources helpful. Structural barriers rather than patient-level variables are likely the primary drivers of low oncologic trial enrollment. Future efforts should focus on improving access to appropriate trials and leveraging the physician-patient relationship for increasing trial participation.
Swabs by emergency responders (SWABBER): Enhancing care beyond the cancer center during the COVID-19 pandemic.
Authors: Allen Olivia S. , Liu Mark , Munjal Kevin , Lomboy Rex , Bhardwaj Aarti Sonia , Abdallah Alma , Massenburg Natalie , Casadiego Shawn , Smith Cardinale B. 
Published: September 2021

97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new policies were rapidly implemented to ensure safety for patients and staff. However, COVID-19 testing requirements presented a barrier for many patients. Outdoor testing in New York City became less feasible during colder months, and oncology patients have additional concerns, such as limited mobility and immunosuppression. To address these barriers, we created an in-home COVID-19 testing program through a partnership between Community Paramedicine and Oncology: SWABBER (SWABS by Emergency Responders). We evaluated patient use of and satisfaction with SWABBER. Methods: SWABBER began in September 2020 as an interdisciplinary initiative to offer in-home, asymptomatic COVID-19 PCR testing for patients on active treatment in an effort to provide more coordinated care and improve patient experience. Tests were performed prior to the first day of each treatment cycle at no cost to patients. Randomly selected patients completed a brief survey about their experiences with the program, with questions on a seven-point Likert scale. Sociodemographic data was collected from the EMR, and we used a chi-square test to identify differences in patient use of SWABBER by race. Results: From September 8, 2020–April 1, 2021, we saw 7,204 patients for infusion, of whom 993 (14%) participated in SWABBER. The cohort of all patients receiving treatment was 45% White, 19% Black, 6% Asian, 29% Other, and 1% Unknown race. The SWABBER cohort was 36% White, 21% Black, 12% Asian, 29% Other, and 1% Unknown race. There was a significant difference in patient race between these two groups (P < 0.00001), with more Black and Asian patients in SWABBER compared to all patients receiving treatment. A total of 406 (41%) SWABBER patients completed the patient experience survey. The mean scores for overall experience and likelihood of recommending the program were 6.9, with standard deviations of 0.56 and 0.44, respectively. Conclusions: SWABBER enabled us to deliver care directly to patients’ homes, mitigating COVID-19 exposure while promoting accessible care and providing an increased benefit for minority patients. Through SWABBER, we achieved near-perfect patient experience ratings, reduced the burden of testing, created a safer environment for patients and staff, and kept cancer care on track. Future work will evaluate ways to maintain elevated patient experience and continue striving for inclusive care beyond the pandemic.[Table: see text]
Health professionals’ attitudes toward religiosity and spirituality: a NERSH Data Pool based on 23 surveys from six continents
Authors: Kørup Alex , Søndergaard Jens , Alyousefi Nada A , Lucchetti Giancarlo , Baumann Klaus , Lee Eunmi , Karimah Azimatul , Ramakrishnan Parameshwaran , Frick Eckhard , Büssing Arndt , Schouten Esther , Butcher Wyatt , Hefti René , Wermuth Inga , de Diego-Cordero Rocio , Menegatti-Chequini Maria Cecilia , Hvidt Niels Christian 
Published: September 2021

Background In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) using individual participant data meta-analysis we updated the NERSH Data Pool. Methods We performed both a network search, a citation search and systematic literature searches to find new surveys. Results We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had “some” influence on their patients’ health (CI95%) (81.8%–84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%–95.5%). Across all samples 649 (16%; 14.9%–17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%–25.4%). Conclusions Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis.
Pressure sensing with high-finesse monolithic buckled-dome microcavities
Authors: Al-Sumaidae S. , Bu L. , Hornig G. J. , Bitarafan M. H. , DeCorby R. G. 
Published: September 2021

We describe the use of on-chip buckled-dome Fabry–Perot microcavities as pressure sensing elements. These cavities, fabricated by a controlled thin-film buckling process, are inherently sealed and support stable optical modes (finesse

>

10

3

), which are well-suited to coupling by single-mode fibers. Changes in external pressure deflect the buckled upper mirror, leading to changes in resonance wavelengths. Experimental shifts are shown to be in good agreement with theoretical predictions. Sensitivities as large as

∼

1

n
m

/

k
P
a

, attributable to the low thickness (

<

2

µ

m

) of the buckled mirror, and resolution

∼

10

P
a

are demonstrated. We discuss potential advantages over traditional low-finesse, quasi-planar Fabry–Perot pressure sensors.
Hybrid photonic-plasmonic cavities based on the nanoparticle-on-a-mirror configuration
Authors: Barreda Angela I. , Zapata-Herrera Mario , Palstra Isabelle M. , Mercadé Laura , Aizpurua Javier , Koenderink A. Femius , Martínez Alejandro 
Published: September 2021

Hybrid photonic-plasmonic cavities have emerged as a new platform to increase light–matter interaction capable to enhance the Purcell factor in a singular way not attainable with either photonic or plasmonic cavities separately. In the hybrid cavities proposed so far, the plasmonic element is usually a metallic bow-tie antenna, so the plasmonic gap—defined by lithography—is limited to minimum values of several nanometers. Nanoparticle-on-a-mirror (NPoM) cavities are far superior to achieve the smallest possible mode volumes, as plasmonic gaps smaller than 1 nm can be created. Here, we design a hybrid cavity that combines an NPoM plasmonic cavity and a dielectric-nanobeam photonic crystal cavity operating at transverse-magnetic polarization. The metallic nanoparticle can be placed very close (

<
1

nm

) to the upper surface of the dielectric cavity, which acts as a low-reflectivity mirror. We demonstrate through numerical calculations of the local density of states that this hybrid plasmonic-photonic cavity exhibits quality factors

Q

above

10

3

and normalized mode volumes

V

down to

10

−
3

, thus resulting in high Purcell factors (

F
P

≈

10

5

), while being experimentally feasible with current technology. Our results suggest that hybrid cavities with sub-nanometer gaps should open new avenues for boosting light–matter interaction in nanophotonic systems.