bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying cancer patients’ care needs after discharge hospital using health claim data linked with Hospital-based Cancer Registry data in Japan.
Authors: Okuyama Ayako , Takemura Yukie , Higashi Takahiro 
Published: May 2019

e18012 Background: In 2018, the 3rd Cancer Control Plan developed in Japan. This plan recommends that we should create a better society for cancer patients to keep living at their homes after leaving hospital. In order to grasp the continuous health care needs, we investigated independence degree of Activities of Daily Living (ADL) at the time of discharge for cancer patients by hospital types. Methods: We analyzed the health insurance claims database linked with the hospital-based cancer registry of 230 cancer care hospitals covered the period from October 2012 to December 2014. Data were abstracted from patients who 1) were diagnosed with breast, lung, liver, colorectal, stomach, pancreas, or prostate cancer in 2013; 2) were 20 years or older at the time of the diagnosis; and 3) received the first course or continuous treatment at the hospital. Ministry of Health, Labor and Welfare designates cancer care hospitals (DCCHs) to provide a high quality of cancer care. In each prefecture, one hospital is designated as Type 1 DCCH, and it has the role of supporting other DCCHs in that prefecture. Remaining DCCHs are Type 2 DCCHs. Hospitals which are not designated as DCCHs are categorized into other hospitals. We assessed the differences of patient’ ADL status by these hospital types. Results: We extracted 37,523 patients’ discharge data (8,271 from Type 1 DCCHs, 28,200 from Type 2 DCCHs, and 1,052 from other hospitals). The mean age (SD) at the time of diagnosis was 65.6 (11.7) at Type 1 DCCHs, 69.1 (11.0) at Type 2 DCCHs, and 70.0 (12.3) at other hospitals. The percentage of clinical stage IV in other hospitals (25.3%) was slightly higher than others (22.5%). In total, 16.2% of patients need all assistance for bathing, while only 3.5% of patients need all assistance for eating. More patients at other hospitals were need assistance for ADL compared to patients at DCCHs. For example, 10.6% of patients need all assistance for bathing in type 1 DCCHs, while 25.2% of patients need it in other hospitals. Conclusions: Many patients discharged in not DCCHs need more assistance for their daily living. We should take these situation into account when we provide appropriate support for cancer patients.
Reduced blood product utilization via implementation of an anemia clinic and consult service in a large health system hospital: Focus on cardiovascular patients.
Authors: Bowers Reid Christian , Korman Sandra Tomany , Thompson Michael A. , Pant Manish Krishna , Sana Sherjeel , Sanchez Federico Augusto 
Published: May 2019

e18014 Background: As part of a system wide implementation of Patient Blood Management (PBM), an Anemia Clinic program was implemented at St. Luke’s Medical Center, Advocate Aurora Health in Milwaukee, WI. Methods: September 2016 the Anemia Clinic started accepting referrals for management of non-cancer anemia, predominantly pre-operative cardiovascular surgery (CVS) Pts. Hgb thresholds were < 13 g/dL in men and < 12 g/dL in women. Non-anemia cytopenias triggered Hematology referral. All Pts were screened for iron, B12, folate, and reticulocyte. Nutrient deficiency received appropriate supplementation. Pts with CKD or chronic disease were eligible to receive erythropoiesis stimulating agents. Results: PBM implementation 2015-2018 resulted in a drop in packed red blood cell (PRBC) usage during a surgical episode (Table). Of 508 CVS Pts pre-operatively anemic in 2018, 155 were referred to the Anemia Clinic and 353 were not. There was not a statistical difference between the referred and the non-referred for percentage of Pts who received PRBCs (65.4% vs. 70.3% Chi-Square p = 0.31). Of preoperatively anemic Pts who were transfused in 2018 an average of 2.23 PRBCs were used in the referred group vs. an average of 2.35 PRBCs in those in the not referred group (Poisson Means p = 0.49). Length of stay (LOS) in the referred group was a median 10d ( P25= 7d, P75 =15d) vs LOS in the non-referred group was a median 11d ( P25= 7d, P75 =20d). LOS analyses of observed-to-expected (O/E) ratios used the Premier Healthcare Providers Alliance Database (PHD) which contains data on approximately 45% of US hospital discharges.. For 2018 through Nov. the referred group was observed to have LOS mgeo = 10.19 days vs LOS mgeo = 11.72 days (N = 141, O/E 0.87). The not referred group was observed to have a LOS mgeo = 12.45 days vs. an LOS mgeo = 10.65 days (N = 311, O/E 1.17). Conclusions: Referral to the Anemia Clinic as part of a broader program of PBM was associated with shorter LOS and a decrease in PRBC use. Implementation of PBM at our institution decreased PRBC use even in patients not referred to anemia clinic due to systematization of best practices. Implementation of our methods as the initial approach to general anemia referrals may increase access and efficiencies in the systemization and treatment of hematologic malignancies. [Table: see text]
Characteristics of medical oncologists participating in the Oncology Care Model.
Authors: Parikh Ravi Bharat , Bekelman Justin E. , Huang Qian , Martinez Joseph , Emanuel Ezekiel J. , Navathe Amol S. 
Published: May 2019

e18017 Background: The Oncology Care Model (OCM) is Medicare’s first bundled payment program for patients with cancer. Because practices voluntarily enrolled in the OCM in 2016, there may be differences between OCM-participating and non-participating oncologists that impact the OCM’s generalizability. We examine baseline characteristics of OCM participants and markets with high OCM physician participation. Methods: In this cross-sectional study, we identified characteristics of US medical oncologists practicing in 2016 using a national telephone-verified physician database. We linked this data with Dartmouth Atlas and Medicare claims data to identify market characteristics of areas with high OCM participation. We used logistic regression to examine relationships between market characteristics and OCM participation. Results: Of 10428 US medical oncologists, 2605 (24.9%) were listed on an OCM-participating practice’s website. There were no differences in sex or medical training between OCM participants and non-participants, although OCM participants were younger. OCM participants were more likely to be affiliated with large, group, and urban practices that were not part of a health system (Table). Southwest, Southeast, and mid-Atlantic markets had higher OCM participation. Markets with high OCM physician participation had higher specialist density, Hospital Care Intensity Index, and acute care utilization at the end of life (all p < 0.001). Market penetration of Accountable Care Organizations (adjusted odds ratio [aOR] 4.65, 95% CI 3.31-6.56, p < 0.001) and Medicare Advantage (aOR 2.82, 95% CI 1.97-4.06, p < 0.001) were associated with higher OCM participation. Conclusions: We found differences in provider and practice demographics, care intensity, and prior exposure to alternative payment models between OCM-participants and non-participants. Differences in practice and market characteristics influence oncologists’ participation in alternative payment models and should be accounted for in Medicare’s OCM evaluation. [Table: see text]
Profile of cancer caregivers among adult Indian rural cancer patients: A prospective survey.
Authors: Pandey Avinash Vijay Kumar , Singh Anjana , Singh Shivkant 
Published: May 2019

e18019 Background: There is lack of information regarding Cancer Caregivers who play predominant role in assisting patients during active treatment and follow –up in India. Aim: To identify profile of cancer caregivers Objectives: To identify, social, economic, familial variables of cancer caregivers of adult cancer patients by prospective survey/questionnaire. Methods: All consecutive individual adult (age≥18 years) patients diagnosed with cancer and registered in Medical Oncology OPD were enrolled for Cancer caregiver questionnaire based survey between July 2018 and October 2018.Primary caregiver was defined as person of first degree relative who has greatest responsibility of daily patient care. Patient was asked to name single preferred primary caregiver in case of multiple first degree relatives available. Results: Of 517 patients enrolled, 456 (88%) were rural.491 (95%) had primary caregivers, while 26(5%) had secondary caregivers only. 295(57%) had 3-4 caregivers, while 117 (23%) had 5-7 caregivers in predominantly joint family population (75%). Among primary caregivers, son 287 (58%) was the preferred choice, followed by brothers, 50 (10%). Only 61 (12%), chose female as primary caregivers. Only 36/281 (13%) married men and 71/215 (33%) married women chose their spouse as primary caregiver. 326 (63%) of primary caregivers had monthly income equivalent to $70-140, while 16% and 9% had between $140-280 and less than $70 respectively.131 (25%) of caregivers were graduate,186 (35%) passed secondary school, while only 25 (4.8%) were illiterate. Conclusions: Majority of rural Indian cancer patients have access to multiple caregivers. Young males are the preferred choice as primary caregiver. Primary caregivers are economically poor but literate.
Real-world assessment of practice efficiency with the introduction of subcutaneous rituximab.
Authors: Qiu Annie , Shapouri Sheila , Drill Esther N. , Schade Jake , Ravelo Arliene , Ni Ai , To Tu My , Dawson Keith Lamont , Matasar Matthew J. 
Published: May 2019

e18025 Background: Rituximab (R), available as an intravenous (IV; R-IV) infusion or subcutaneous (SC; R-SC) injection, is used in the treatment of follicular lymphoma (FL), diffuse large B-cell lymphoma (DLBCL), and chronic lymphocytic leukemia (CLL). This study evaluated real-world practice efficiency changes associated with the adoption of R-SC by studying differences in chair time by route of administration. Methods: We conducted a retrospective analysis of practice care delivery measures before and after adoption of R-SC at Memorial Sloan Kettering Cancer Center (MSKCC). Data for patients (pts) with FL, DLBCL, or CLL receiving R-based therapy from September 2016 to September 2018 were extracted from the electronic medical record. A linear mixed effect multivariate model with random intercept was used to analyze the association between treatment type (R-IV vs R-SC) and chair time (defined as the difference in pt room-in and room-out times) in the year prior to and following R-SC adoption at MSKCC. Model covariates included treatment time and location, therapy type (monotherapy vs combination), and pt demographics. Given the prolonged infusion time, patients’ first dose of R-IV was excluded from the analysis. Results: Data were collected during 6744 visits (3018 visits prior to R-SC adoption and 3726 after) for 1503 pts receiving R. Pts receiving R-IV combination therapy had a mean chair time of 203 minutes (min); overall, R-SC injection reduced chair time by a mean of 92 min (p < 0.001 vs R-IV). Monotherapy, regardless of route, reduced chair time by a mean of 30 min (p < 0.001) compared with combination therapy, and mean chair time was further reduced by 39 min (p < 0.001) for R-SC pts receiving monotherapy. Reductions in chair time increased over time following initial adoption of R-SC (p = 0.042), and were greater at the lymphoma-specific site than multispecialty oncology infusion centers (p < 0.001). Conclusions: Adoption of R-SC results in substantial time savings for both the pt and health system as measured by reduced chair time and improved pt throughput. Given increasing constraints on infusion chair space, increased utilization of R-SC may improve practice efficiency and pt access to care.
Case discussion at cancer multidisciplinary meetings: What resourcing is required?
Authors: Mitchell Paul , Soon Jennifer , Kenny Joanne , Simons Katherine 
Published: May 2019

e18026 Background: Discussion of cancer cases at multi-disciplinary meetings (MDMs) is expected standard care in Australia. To our knowledge there are no local, and few international, data on the resourcing required for MDMs. Methods: Data covering 12 months of MDM activity at Austin Health, Victoria, were obtained retrospectively. Prospective data were also collected over 4 weeks focusing on time required for preparation and post-meeting activities. Capital, maintenance and general overhead costs were not included. Results: MDMs covered 15 tumour areas: 11 solid tumour, one lymphoma and 3 haematological. Over 12 months 452 MDMs were held, discussing 5943 patients with highest case volume for hepatoma (1243), breast (1084) and hepato-biliary (HPB, 679). On average 12 cases (range 3.5 – 38.3) were discussed per meeting, with average 3.8 minutes spent per case. An average of 3 imaging studies were reviewed per case and 60% of cases in the high volume MDMs required access to external imaging. Imaging consultants spent an average of 2.9 minutes preparation per imaging study, registrars 5.2 minutes and external imaging required 7.8 minutes per study. Pathologists spent an average of 6.8 minutes preparation per case, which rose to 9.4 minutes for external cases (making up between 3% - 30% of cases per MDM). Pathology administration time was 53 minutes per meeting. The mean cost of medical staff was AUD 1617 per meeting (range $532-$2860), and 78% of the cost was for consultant medical staff. The mean cost for diagnostic staff attendance was $216, and preparation $327. MDM and pathology administrative costs were $273. The MDMs with the highest annual total costs were breast, lung and HPB ($152,904 - $207,289). The overall mean cost for a meeting varied between $847 - $4080. The cost per case discussed varied from $106 - $422, with generally lower per-case costs for the high case volume MDMs. The average per case cost was $255. Conclusions: Data on staff time and costs associated with conducting cancer MDMs were able to be obtained. The average cost per case discussed was $255 (USD 184). These data may be useful in planning to extend MDM discussion to include a higher proportion of cancer cases and in seeking additional funding.
Staging the development and implementation of a Coordinated Cancer Care Model using risk-based survivorship care: A deliberative discussion among multiple stakeholders.
Authors: Tremblay Dominique , Bilodeau Karine , Prady Catherine , Touati Nassera 
Published: May 2019

e18027 Background: Risk-based survivorship care has become one of the best practices care recommended by the Institute of Medicine. It involves coordinated follow-up services based on the risk of long-term and late effects, cancer recurrence and an individualised care plan. Risk-based care requires specific knowledge about cancer histology, treatments, and potential consequences of cancer and its treatment to guide surveillance, screening and counseling. Diagnostic and treatment details and their associated health risks may not be known by survivors or their multiple care providers. Implementing risk-based survivorship care is often challenging for providers. This presentation report on a deliberative workshop on the development and planning of a risk-based survivorship care model. Methods: The deliberative workshop is part of a larger study in two regional cancer networks in Quebec, selected for there differences (geographic location, population size, academic mandate). A total of 25 key informants (researchers, managers, family physicians, oncologists, cancer survivors, nurses, social workers) participated into the workshop on October 2nd, 2018. Deliberative discussion between local stakeholders followed by videoconference, getting together stakeholders from both networks was drawn from Gupta et al 3 steps: 1) identify the problem; 2) develop the innovation; 3) design the pilot test. Results: Although the context of the network was different, main issues were similar: 1) there is no common understanding of the concept “risk-based survivorship care”, either for survivors, primary care providers and cancer specialist; 2) “silo functioning” within and between teams is a main barriers to ensure care coordination based on risk assessment; 3) organizational assets should be formalized to insure safe coordination of survivorship care based on cancer risk assessment. Conclusions: Given the recognized importance of risk-based survivorship care and implementation challenges, deliberative discussions may provide a useful lens to inform translation of this model into real practices and guide empirical studies.
Development of a patient-oriented navigation model for lung cancer patients.
Authors: Holmberg Christine , Gödde Kathrin , Fuegemann Hella , Mueller-Nordhorn Jacqueline , Rieckmann Nina , Goerling Ute 
Published: May 2019

e18033 Background: Patient navigation is seen to support and enable patient-oriented, optimal care both in palliative and in screening settings. However, the evidence remains inconclusive on what patient groups are best targeted by navigation and what may be improved by such a care model. Lung cancer patients are at particular risk for sub-optimal care because they face complex care trajectories due to severe and rapid disease progression and accompanying comorbidity. Methods: To develop a navigation model for lung cancer, we conducted a mixed-methods study to investigate who may be at risk of receiving sub-optimal care in the German health care setting. To capture the patient perspective a longitudinal qualitative component was included with patients (N = 20) assessed at three dtime points. In addition, a secondary data analysis of cancer registry data of a comprehensive cancer center was conducted and a repository of patient support offers gathered. Results of the study components were integrated to develop a patient-oriented navigation model. Results: Secondary data analysis showed that medical care functioned according to tumor board recommendations. Patient data revealed institutional barriers that conflict with individual needs and preferences. A lack of contact persons, information provision as well as bureaucratic difficulties were identified. Patients without a social network seem particularly in need for support. Identification of regional support offers shows that there are resources available to meet some of these needs. However, knowledge on such offers was not common among patients and caregivers. Navigators should provide practical support, give advice on social care issues and refer to existing support offers. Conclusions: Social networks crucial. Patients lack knowledge to use available resources. Navigation needs to be implemented within existing care structures to reach patients.
Developing an adolescent and young adult (AYA) cancer program in an Italian adult high-volume cancer center.
Authors: Bertuzzi Alexia , Marrari Andrea , Quagliuolo Vittorio , Cananzi Ferdinando , Cariboni Umberto , Specchia Cristina , Bragato Renato , Balzarini Luca , Scorsetti Marta , Navarria Pierina , Siracusano Licia , Mencaglia Emanuela , Vicenzi Elena , Spinelli Antonino , Santoro Armando 
Published: May 2019

e18034 Background: Given the lack of survival improvement and the several unmet clinical/psychosocial issues, programs for AYA (15 to 39 yo) are underway, involving local resources and organizations. Conventionally the healthcare system address inadequately the needs of AYAs. Humanitas Research Hospital is a high volume Cancer Center for adult patients with long lasting expertise in rare cancers based on a multidisciplinary approach. Methods: We conducted a retrospective evaluation of the number of patients followed in our Institute from 2010 to 2017 to assess our potential as an AYA referral center. In February 2017 we started a dedicated program, focused on medical and psychosocial issues of AYA and supported by an interdisciplinary team including medical oncologists, psychologists, surgeons, radiation oncologists, fertility experts, cardiologists, genetic consultants, endocrinologist, palliative care providers, social workers, and liason nurses . Results: From 2010 to 2017 more than 6600 AYA pts were seen in Humanitas. The epidemiology reflects the published data. Since the beginning of the program (February 2017), more than 2000 new AYA pts were referred to our dedicated clinic. Based on a patient-focused model of care, the aims of the first access are the comprehension of the complex pathways to diagnosis often delayed, the access to optimal care including clinical trial, the recognition of the unique psychosocial context, the counselling on key issues for AYA (fertility, cardiology, nutrition, smoking, financial). We created a dedicated physical space where pts, families and caregivers can spend time together, reducing the feeling of isolation. They meet also specialists trained to deal with their needs, to reduce the adverse impact of the diagnosis and to improve the adherence to treatment. Daily activities, such as cooking and photography class, professional writing and acting, are also offered. Conclusions: Humanitas AYA project modified the hospital environment making it more comfortable for our pts and improved the awareness of the healthcare providers to AYA unmet needs. Outcome and research program improvement are long-term endpoints to bridge the clinical gap of AYA pts.
Pursuit of performance: An exploration of predictors associated with achieving performance based payments for breast cancer episodes under the Oncology Care Model.
Authors: Song Andrew Jehyun , Kee Arianna , Minetola Jared , Walsh Karen , Csik Valerie P , Leader Amy , Maio Vittorio 
Published: May 2019

e18035 Background: The Oncology Care Model (OCM) captures patient costs in a 6-month episode triggered by administration of systemic therapy. Most breast cancer (BC) patients will receive systemic therapy, with variations depending on stage and hormonal status, which makes BC an ideal indication to study costs in the OCM. Practices earn performance based payments (PBP) if aggregate episodic expenditures are managed below set target prices. We investigated predictors for episodic expenditures exceeding target prices, thus reducing potential for PBP. Methods: We identified BC episodes with non-decedent beneficiaries attributable to our academic medical center from OCM Reconciliation Reports during 7/1/16-6/30/17. Cohorts were defined as episodes whose costs were above target (Cohort 1) and those below (Cohort 2). The Wilcoxon Rank-Sum test was used to compare actual and target episode expenditure between cohorts. Multivariable logistic regression models were used to assess association of maintaining costs below target due to various predictors. Results: A total of 369 episodes were included in the study, with 124 episodes in Cohort 1 and 245 in Cohort 2. Median actual and target episode expenditures were higher in Cohort 1 (actual: $23,466 vs. $2,691, p < 0.0001; target: $8,425 vs. $5,870, p < 0.0001). In multivariable logistic regression, episodes were more likely to be below target if novel therapies, Part B drugs, or inpatient admissions were not utilized, controlling for other predictors (see Table). Conclusions: Large disparities exist for both actual expenditures and target prices for BC episodes in the OCM. Novel therapies, Part B drugs, and inpatient admissions are negatively associated with maintaining episode expenditures below target. Risk-adjustments for these expenditures need to be overhauled in OCM to accurately capture costs associated with management of cancer patients, and provide practical target prices for institutions to continue delivery of value based care. [Table: see text]