bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Oncology Care Model (OCM) on episode costs and performance revenues: Considerations for oncology practices.
Authors: Shenolikar Rahul , Ryan Kellie , Shand Ben , Kane Richard 
Published: September 2018

102 Background: The OCM is focused on providing high-quality, cost-efficient oncology care in Medicare. The episode payment approach introduces performance-based payments (PBPs) alongside traditional fee-for-service reimbursements. There is not yet a clear picture of the impact of the OCMs implementation on oncology practices. Methods: Using the Medicare Standard Analytic Files (5% sample) Part A and B claims, this study replicates the OCM benchmarking payment methodology. OCM episodes were triggered by qualifying Part B cancer therapies administered in an outpatient setting; all Part A and B costs that occurred in the following 6-months were included in episode costs. Claims for the baseline period (July 2012 – June 2015) were used to calculate actual episode costs, and predicted episode costs were used for benchmarks. Claims were also used to estimate OCM claims-based quality measure scores. Quality measure scores determined a practice’s performance multiplier, which is part of the PBP calculation. Results: The average ratio of OCM actual-to-predicted costs varied by tumor type. Of the 21 tumor types, 12 underpredicted costs and 7 overpredicted costs. The underpredicted tumors accounted for 43% of OCM episodes, and the overpredicted account for 51%. Central nervous system tumors and malignant melanoma were the most underpredicted cost ratios at 1.29 and 1.27, respectively. Claims-based quality measures also varied by tumor type. Aggregate scores for the three claims-based measures were < 50% for 18 tumors (65% of episodes) and ≥50% for 3 tumors (35% of episodes). Practices treating patients with tumors that are underpredicted on cost and/or score low on quality measures will have greater difficulty achieving PBPs. Conclusions: This analysis suggests that the ability of a participant to succeed in the OCM will vary depending on the types of cancers treated at the practice. Both savings and quality, as measured by OCM, will vary across cancers. For some cancers, achieving an ‘average’ cost and an ‘average’ quality score could result in below-average performance for the practice. Understanding these dynamics are critical to understanding the potential impact of the OCM at the practice level.
The quality of breast cancer quality measures.
Authors: Lane Whitney , Rushing Christel , Nussbaum Daniel , Blazer Dan G. , Greenup Rachel Adams 
Published: September 2018

108 Background: To assess quality in breast cancer care, standardized metrics are needed. Many accepted breast performance metrics are based on evidence-based practice; however, most fail to reflect patient choice in treatment decisions. Given the focus on patient-centered breast care, we sought to determine how compliance with established quality metrics correlates with receipt of breast cancer care impacted by patient preference. Methods: American College of Surgeons (ACS) National Cancer Data Base facilities were designated compliant or non-compliant based on Commission of Cancer (CoC) breast metrics MASTRT, BCSRT and HT*, which all improve survival. Compliant facilities met the expected performance rate (EPR) for all three metrics, while non-compliant facilities failed to meet the EPR for any. Rates of breast conserving surgery (BCS) for early stage cancer, immediate breast reconstruction (IBR), and contralateral prophylactic mastectomy (CPM) are proposed metrics that are impacted by patient preference. For these, quality is defined as high rates of BCS, high rates of IBR, and low rates of CPM. Multivariable logistic regression models were used to estimate the association between facility level rates on these measures and the probability of treatment at a CoC compliant facility. Results: 729 facilities were included in the analysis. Based on the CoC measures, 79 (10.8%) were considered compliant and 650 (89.2%) non-compliant. Rates of BCS and IBR did not differ between compliant and non-compliant facilities; however, women treated at compliant facilities were more likely to undergo CPM (26.3% vs 21.4%; p = 0.02). In a multivariate model treatment at compliant facilities was associated with higher rates of BCS, IBR, and CPM; however, the predictive value of these metrics was minimal (Estimated OR range: 1.01-1.03). Conclusions: Rates of preference driven therapies do not differentiate CoC compliant and non-compliant hospitals. The quality of a hospital’s breast care is likely poorly measured by metrics that are influenced by, but cannot account for patient values. *MASTRT (RT≤1yr of diagnosis in women with ≥4 +lymph nodes); BCSRT (RT ≤1yr of diagnosis for women ≤70 receiving BCS); HT (hormone therapy recommended ≤1yr of diagnosis for HR-positive breast cancer)
Transition of dose-adjusted EPOCH therapy into the outpatient healthcare setting: Quality and cost considerations for outpatient treatment.
Authors: McBride Ali , Yiu Kelly , Elquza Emad , Persky Daniel Oscar , Kumar Abhijeet 
Published: September 2018

110 Background: Dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin (EPOCH)-containing regimens are frequently utilized in lymphoma, however, outpatient EPOCH or modified inpatient/outpatient EPOCH has not been described extensively. We transitioned inpatient EPOCH to the outpatient setting and modified EPCOH to be given in the inpatient setting with rituximab outpatient to improve quality of care and access to patient assistance programs. We describe our institutional experiences with inpatient and modified EPOCH to the outpatient setting. Methods: A single-center, institutional review board-approved retrospective study was conducted for adults receiving EPOCH-based regimens. Clinical and financial data were collected by chart review for each patient. Descriptive statistics were utilized for analysis. Results: A total of 31 patients received 116 cycles of an EPOCH-containing regimen (11 [9.5%] inpatient), 54 [46.5%] outpatient, and 51 [44.0%] hybrid inpatient and outpatient). Nine outpatient cycles, 9 (17.6%) hybrid cycles and no inpatient cycles resulted in admissions for FN. Two inpatient cycles were delayed (18.2%) due to disease-related procedures and one (9.1%) was delayed due to low blood counts. Five (9.2%) outpatient cycles were delayed due to logistics (i.e. insurance delays, scheduling errors) and two (3.7%) outpatient cycles were delayed due to disease-related adverse events (bowel obstruction, chest pain). Transitioning EPOCH to the outpatient setting decreased overall costs for hospital stays on average by $19,792 per cycle with an overall approximate cost savings to the health-system of 1,114,992 dollars with 432 bed days saved. Costs savings to patients with medications assistance programs is pending final analysis. Conclusions: EPOCH-containing regimens can be safely transitioned into the outpatient setting, side effects can be monitored and outcomes optimized, to better adapt treatment strategies for individualized patient therapies. As new healthcare payment models are developed, outpatient treatments allow for adaptive financial options both for the health-system and the patient.
Variations in hospitalization and emergency department or observation (ED/OB) stays using the oncology care model (OCM) methodology in Medicare data.
Authors: Li Shuling , Peng Yi , Li Suying , Raskin Leon , Kelsh Michael Anthony , Zaha Rebecca , Gawade Prasad L. , Henry David 
Published: September 2018

112 Background: The Medicare OCM started in 2016 to improve oncology care and reduce costs. Two metrics for care evaluation are hospitalizations and ED/OB stays. Baseline data (2012−2015) on variations in all-cause hospitalization and ED/OB stays not resulting in hospitalization in the 21 reconciliation-eligible cancer types are not well characterized. Methods: We applied OCM methodology in Medicare fee-for-service 20% sample data to estimate 6-month patient (pt) episodes triggered by chemotherapy, as well as associated cancer type and practice, from 2012 to 2015. Proportions of episodes with hospitalization and ED/OBs stay were summarized overall and by cancer for all episodes and by practice in those with ≥20 pt-episodes. Results: In total, 485,186 pt-episodes at 13,823 practices were identified (mean episodes/practice, 35.1; median, 2; IQR, 1–15). The mean number of episodes/pt was 1.90 overall (from 1.17 in anal cancer to 2.32 in multiple myeloma [MM]). The proportion of episodes with hospitalization was 25% overall (from 14% in breast cancer [BC] to 56% in acute leukemia) and with ED/OB stays was 23% overall (from 18% in BC to 36% in liver cancer). In 2,995 practices with ≥20 total episodes, at practice-level, the proportion of episodes with hospitalization ranged (20th–80th percentile) from 14% to 31% and with ED/OB stays from 17% to 29%. For select cancers, the range of proportion of episodes with hospitalization and ED/OB stays were highest for lung cancer (LC) and lowest for BC (Table). Conclusions: The proportion of 6-month OCM episodes of care with hospitalization and ED/OB stays after chemotherapy varied by cancer and was higher for certain solid and hematological malignancies. Variations between practices and cancers are important factors when evaluating OCM performance. [Table: see text]
The impact of value-based payment on the referral of oncology patients to tobacco cessation services.
Authors: Bedard Louise , Griggs Jennifer J. 
Published: September 2018

116 Background: The purpose of this study is to investigate the relationship between the introduction of value-based payment, the initiation of a quality improvement project, and practices’ performance to refer or administer tobacco cessation counseling to patients. Methods: The Michigan Oncology Quality Consortium (MOQC) is a statewide quality collaborative sponsored by Blue Cross/Blue Shield of Michigan (BCBSM). MOQC uses ASCO's Quality Oncology Practice Initiative (QOPI) for measurement.Value-based payment (VBP) was introduced in 2017 by BCBSM. The VBP is achieved if a region reaches a target established for four QOPI measures. One of the four quality measures is QOPI's core measure 22bb: tobacco cessation counseling administered or patient referred. At the time the VBP was introduced, a subset of MOQC practices chose to initiate a quality project to improve performance on this measure. Analyses describes the performance of all MOQC practices with the introduction of the VBP, and performance of the practices who chose to revise their tobacco cessation processes to address performance. Results: The proportion of patients who were administered or referred to tobacco cessation services in participating MOQC practices was 49% (n = 793 charts) from abstracted rounds Spring 2014 - 2017. After the introduction of VBP, this proportion increased to 58% (n = 307 charts) in Fall 2017. Performance improved on this QOPI measure for both subsets of MOQC practices - those practices that chose to initiate a quality project focused on this measure (n = 19) and practices that selected another measure (n = 27). Practices that developed a quality project improved their aggregate proportion from 46% (Spring 2014-2017, n = 839 charts) to 51% (Fall 2017, n = 266 charts). Practices that focused on another quality measure improved from 51% (Spring 2014-2017, n = 789 charts) to 65% (Fall 2017, n = 265 charts). Conclusions: Our data suggest that the presence of VBP may have had a positive impact on referral patterns for tobacco cessation services for cancer patients. Additional analyses are required to determine if there is a combination or sequencing of VBP and process improvement strategies to optimize the delivery of quality care.
Clinical work intensity among medical oncologists.
Authors: Hudson Matthew F. , O'Rourke Mark Allen , Blackhurst Dawn W. , Caldwell Jennifer , Franco Regina A. , Russ-Sellers Rebecca , Horner Ronnie 
Published: September 2018

118 Background: Oncology faces workforce shortages and increasing stress. Oncology provider well-being and resilience are mediated by organizational factors through clinical work intensity. Clinical work intensity (CWI) is the level of requisite technical skill, physical and mental effort and clinical judgement necessary, plus care provision-associated stress. Suboptimal clinical work intensity may result from unfavorable practice organizational factors preceding burnout. This pilot study assess CWI experienced by medical oncologists and oncologic advanced practice registered nurses (APRNs)/nurse practitioners as a prelude to a study of provider resilience. Methods: Investigators solicited seventeen medical oncologists-12 physicians and 5 nurse practitioners-from five oncology clinics in the Northwest, Midwest, and Southern regions of the United States Providers reported on level of work intensity associated with 339 patient visits occurring over an 8 week period where for each provider 5 visits were randomly selected from each of 4 randomly selected clinic days. Intensity was measured by the NASA-Task Load Index that assesses 6 dimensions (subscales) with additional questions measuring stress and visit satisfaction. Results: Compared to medical oncologists, APRNs reported a higher work intensity score on average (38.6 vs. 32.9; p < 0.0064), and higher scores on the frustration subscale (36.5 vs. 21.5; p < 0.0001). APRNs also scored higher on stress (27.8 vs. 22.2; p < 0.048), and scored lower on provider-perceived satisfaction with the visit (73.0 vs. 81.1; p < 0.0001). There was no difference between oncologists and nurse practitioners on the other dimensions, including mental, time, and physical demand, and effort. Conclusions: Oncologic APRNs may experience greater work intensity than medical oncologists. Future research will consider whether APRN work intensity scores reflect different or disproportionate challenges owing to scope of practice, workload, or administrative responsibilities, and determine those dimensions of higher work intensity that portend provider burnout. The goal is to identify strategies optimizing work intensity among oncology providers, mitigating provider burnout and enhancing the practice environment.
Training staff in a virtual unit.
Authors: Rawlinson Traci , Bartholet Todd , Tonne Heidi 
Published: September 2018

119 Background: Nebraska Medicine, a 600 bed academic medical center, had 24 inpatient oncology beds. In order to grow the oncology population, planning for the Fred and Pamela Buffett Cancer Center began. The new center would include 108 inpatient beds on four units: acute, specialty, progressive, and intensive levels of care. A year in advance, plans were initiated to onboard newly hired nurses of various clinical backgrounds with the goal of creating a competent, cohesive health care team. Despite challenges of a nursing shortage in a competitive market and construction of the facility underway, the oncology leadership team developed innovative ways to orient the large number of new staff. Collaboration with existing inpatient units throughout the organization was instrumental in achieving this goal. Methods: The oncology leadership team developed a process to deploy nursing staff into a variety of inpatient units throughout the organization. A partnership was established involving inpatient managers and hospital educators to track progress and learning needs of each individual during the orientation process. Key components were consistent communication between the leadership teams, and ensuring exposure to the relevant oncology patients, procedures and providers. To provide additional support, an existing Oncology Nurse Fellowship program was adapted and utilized to educate on the holistic care of oncology patients. Day in the life scenarios were developed to expose staff to the new space. Lead Nurses for each inpatient unit received additional development training. Team building exercises and staff meetings contributed to creating positive working relationships. Results: A year later 73 nurses and 48 patient care technicians (PCT), along with the inter-professional team, were prepared to competently and holistically care for patients upon opening of the cancer center. Collaboration with 14 units, including the hospital float pool, yielded impressive results. 84 nurses participated in the Oncology Nurse Fellowship program and 62 PCT’s attended Oncology 101, a specific training for PCTs. Conclusions: Through collaboration and innovation, it is possible to orient clinical staff to create a competent, cohesive team before a physical nursing unit exists.
Quality assessment of tumor boards across an academic and community cancer network.
Authors: Roberts Daniel Aaron , Stuver Robert , Schillevoort Igor , Zerillo Jessica A. 
Published: September 2018

122 Background: Cancer tumor boards (TB), or multidisciplinary team meetings are standard of care in oncology care worldwide. Specific components are described by the American College of Surgeon's Commission on Cancer Program. Most data show consistent improvement in outcomes including a change in diagnostic findings, treatment, and possibly improved survival with TBs. Methods: We adapted a performance assessment tool based on a validated survey implemented in the United Kingdom. An initial survey aimed at assessing tumor board structure and design was sent to 21 TB leaders, and subsequently a tumor board quality assessment survey was sent to 175 participants throughout an academic and community network. The quality assessment survey required participants to identify an answer on a 5-point Likert scale in the categories of "very poor, poor, average, good, and very good". Results: TB leaders representing 16 of 21 (response rate 76%) TBs responded to the structure/design survey. Twelve TBs were from the academic center and included diseases such as Gynecologic Oncology, Cutaneous Oncology, Genitourinary Oncology, and Sarcoma, while four were from community sites. TB leaders indicated that 55% of TBs did not receive CME credit and 60% did not document their recommendations. One hundred eleven TB participants of 175 (response rate 63%) responded to the quality assessment survey. Participants identified the following strengths: 1) all relevant subspecialties present for meetings, 2) respectful teamwork and culture, and 3) operating on an organized agenda. Areas for improvement included: 1) inconsistent tumor board recommendation documentation and 2) post-meeting coordination of care. Results were reviewed with network and cancer center leadership as well as with the Cancer Committee. Conclusions: We assessed our own tumor boards across our cancer network by utilizing an adapted version of a validated TB performance measurement tool for the first time in the United States. Through this assessment we identified key areas for improvement including the need for obtaining CME credit for TB attendance, and developed a policy, process, and template for documenting TB recommendations in an easily accessible centralized location.
Development of a financial navigation program to ease the burden of financial toxicity.
Authors: Monak Melissa , Rodgers Georgina T. , Bell Kimberly , Whitt Antoinette , Gamble Shontia , Jones Laron , Mason Tamara , Lewis Ni'Ema 
Published: September 2018

124 Background: Due to the rising cost of cancer care, even well-insured patients are at risk for financial toxicity. Cancer treatment costs can be challenging for patients and families because of increasing deductibles, increasing premiums and frequent co-payments. At Cleveland Clinic Cancer Centers, our goal is to identify patients at risk for financial distress and help ease the financial stress and hardship associated with cancer care. Methods: The Financial Navigator (FN) role was created in 2016 to complete benefits investigations to determine covered services and minimize the patient’s out of pocket expenses. We are participants in the Oncology Care Model and are expected to provide and document the estimated out-of-pocket costs in the patient’s medical record. Navigators conduct telephone outreach calls with treatment patients to educate them on their benefits. The FN also assists with applications on copay assistance and free drug options. Finally, the FN will connect patients with resources for premium assistance and household expenses when copay assistance isn’t an option. The FN team has grown to 7 FTE’s since 2016. Results: Since 2016 the dollar amount approved through copay assistance applications has increased by 65%, the free drug value received increased by 62%, and YTD 2018 data shows that we have surpassed all of 2017 in what we collected towards patient out of pockets from copay assistance programs. We have also been able to comply with the out of pocket expense metric for OCM, not only for our Medicare patients, but for all of our treatment patients and compliance has risen from 44% in December 2017 to 98% in April 2018. Conclusions: In conclusion our Navigators have built relationships with Social Workers, Care Coordinators, and community services that are available to patients. This added benefit helps patients with non-medical financial stressors. The team can connect patients to organizations that can assist with household utilities, childcare concerns, food concerns, and mortgages. Utilization of the FN role has helped the healthcare team and patients to identify ways to mitigate the costs of care and distress related to financial concerns.
Chemotherapy wait times in a network of pediatric oncology clinics.
Authors: Russo Carolyn Lucille , Morgan Jennifer , Elsaid Mohamed 
Published: September 2018

127 Background: Optimizing care delivery is a satisfier for patients and providers alike. Inadequate clinic flow may also drive up costs, as staff are more likely to utilize overtime hours. We noted in our network of outpatient pediatric oncology clinics that the lowest scores in patient satisfaction surveys were the category of waiting time in the chemotherapy area. We aimed to reduce wait time in the chemotherapy area for patients receiving outpatient, lab-dependent, intravenous push chemotherapy by 5% within 9 months. Methods: A team consisting of a nurse team leader and core members (physician, nurse and pharmacist) from affiliate clinics in 3 states (AL, MO, OK) obtained baseline data over 2 weeks. Data included 1) patient arrival time, 2) lab collection time, 3) lab result time, 4) chemotherapy order time, 5) chemotherapy delivery time to clinic, 6) chemotherapy administration time. Each clinic created their individual process map and cause/effect diagram. Additional measures collected were patient satisfaction scores, parent and staff surveys before and after the intervention. Each clinic site met weekly and the network of the 3 clinics met monthly to review all results. Using the baseline data, each clinic identified points in care where interventions could reduce chemotherapy wait time based on reviewing their own and other clinics’ data. Interventions included moving lab collection earlier in the visit, additional pharmacy staff to deliver chemotherapy and placing an electronic monitor to alert providers when lab resulted. Results: Within 4 months of the interventions all sites had a reduction in chemotherapy wait times (Site A 144m-pre, 134m-post; Site B 163m-pre, 140m-post; Site C 137m-pre, 116m-post). Parent and staff surveys are in process. Conclusions: Each clinic was able to reduce chemotherapy times using different interventions depending on their internal process, moreover each clinic learned how to improve from each other’s processes.