bluuebunny/crossref_metadata_2025_split huggingface dataset:
Leveraging the electronic medical record (EMR) to improve sepsis care in cancer outpatients.
Authors: Dunson William A. , Erickson Emily , Freckleton Chad , Saseendran Mahima , Kissell Betsy , Graves Kencee , Horton Devin , Rohm Terrell , Milligan Donald , Ose Dominik 
Published: September 2018

319 Background: Sepsis is a life-threatening organ dysfunction caused by a dysregulated response to infection and a major healthcare problem in cancer patients. Patients with cancer are at increased risk of morbidity and mortality from sepsis. Approaches like the modified Early Warning Score (mEWS) could offer an opportunity to identify patients at risk for sepsis earlier and to prompt a timely evaluation. However, available evidence for cancer outpatient settings remains scarce. The aim of this presentation is to describe first results of the mEWS implementation at Huntsman Cancer Hospital (HCC) outpatient clinics. The question, whether patients with sepsis can be detected using this approach will be answered. Methods: In 2015, the University of Utah Healthcare implemented mEWS as prediction tool for sepsis. The automated calculation of mEWS is based on real-time data from the EMR. For this analysis, we extracted a cancer outpatient population from a 15-month time frame (from December 2016 to February 2018) within the EHR. We selected patients with a mEWS > 4, grouped these patients according to the process of care after mEWS scoring (e.g., admitted to ICU) and analyzed subgroup based upon mEWS score, discharge disposition and sepsis diagnosis. Results: Within the analyzed time frame 502 cancer outpatients had a mEWS score of 4 or higher. 88 of these patients (17.5%) were diagnosed with sepsis after mEWS screening. Out of the patients with sepsis, 22 were admitted to ICU, 63 were admitted to a medical floor and 3 were treated at the Huntsman Acute Care Clinic. Out of the 414 without a diagnosis of sepsis, 13 patients were admitted to ICU, 72 patients were admitted to a medical floor (in each case for other reasons then sepsis) and 329 patients were sent to home. Conclusions: Sepsis is a serious problem in cancer outpatient care. In our analysis, one in six patients with a mEWS score of 4 and higher were diagnosed with sepsis. This analysis has shown that the implementation of a real-time, EMR based scoring system like mEWS can support the early detection and treatment of sepsis in this population.
Annual colorectal cancer screening in rural community clinics using the fecal immunochemical test (FIT): Second and third year screening.
Authors: Arnold Connie , Davis Terry C , Morris James , Mills Glenn Morris 
Published: September 2018

35 Background: Colorectal cancer (CRC), the second leading cause of cancer death in the US, can be significantly reduced if it is detected early. Although overall CRC screening rates have increased significantly, disparities persist among low income individuals, adults with low literacy and those living in rural areas. Methods: Randomized controlled trial to assess the effectiveness of 2 health literacy informed phone follow-up strategies to improve annual screening with Fecal Immunochemical Test (FIT) in 4 rural community clinics. Eligible patients, age 50-75, were recruited. After consenting, a research assistant (RA) recommended screening and gave literacy and culturally appropriate education using a pamphlet, the FIT kit, simplified instructions and a demonstration of how to use it, At 4 weeks patients who had not returned their kit receive either 1) a personal follow-up call (PC) from a central RA using motivational interviewing skills and reminding them to complete FIT kits; or 2) an automated follow-up call (AC) using plain language and motivational messages encourages patients to complete the FIT. During years 2 and 3, FIT kits were mailed to patients. Follow-up call procedures previously used were followed. Results: 620 patients not up-to-date were enrolled: 308/AC & 306/PC; 66% were African American, 55% women; 40% had limited literacy. During Year 1, 69% completed screening in AC arm versus 67% in PC arm. During Year 2, percentage screened decreased: 40% screened in AC arm and 37% in PC arm. Number of patients that needed at least one follow-up called increased: 74% in both arms needed at least 1 reminder call. Among those called, 19% in the AC arm completed their kit versus 15% in the PC arm. To date in Year 3, 32% screened in AC and 34% in PC. Conclusions: Simplified instructions accompanied by a face-to-face demonstration of FIT, use of “teach back” to confirm understanding with a follow-up call if needed, facilitated completion rates of all patients, particularly those with limited literacy. The less costly and time consuming automated call was equally effective as a personal call. Screening rates in years 2 and 3 declined. CRC screening with FIT is only effective when completed annually. Clinical trial information: RSG-13-021-01 - CPPB.
Supportive measures to enhance clinical trial data management in oncology community network practices.
Authors: Johnson Elizabeth Anne , Andersen Jay C. , Smith Sandy , Patel Bharat , Night Susan S. , Steckel Lauren 
Published: September 2018

38 Background: As an innovative industry leader of Research Site Management Organizations, US Oncology Research (USOR) sought to develop a best practice to support over 65 community practice network sites to comply with Sponsor data entry expectations. Efforts led by the Clinical Trial Manager (CTM) focused on bringing research site awareness to priority data, Sponsor deadlines, and weekly performance feedback via the ‘Healthy Data Habits Pathway’. Methods: The Healthy Data Habits Pathway was created to define the role of CTM involvement in data management operations on behalf of USOR. In collaboration with Sponsor, the USOR CTM reviewed data management reports weekly for data entry trends. Results: Two separate oncology clinical trials (different Sponsors) implemented the Pathway with renal and breast oncology indications. The renal trial demonstrated an almost 90% reduction in total query count for 8 sites in 7 months while the breast trial reported 7 of 14 sites (50%) meeting Sponsor goal of 20 or fewer total queries in 13 weeks. Interventions included emailed notifications, site manager calls, and weekly CTM-Sponsor collaboration teleconferences. Conclusions: Clinical research Sponsors and sites both strive towards maintaining data integrity in an ever-evolving atmosphere of complex oncology trials and increasingly-detailed data capture requirements. Implementation of Pathway interventions increases site and Sponsor engagement in daily data management operations. [Table: see text]
Real-world genetic testing patterns in metastatic colorectal cancer: Balancing adoption challenges with performance efficiency.
Authors: Casebeer Adrianne Waldman , Long Charron , Drzayich Jankus Dana Angela , Racsa Patrick , Rogstad Teresa , Loy Bryan A. , De Souza Jonas A. 
Published: September 2018

46 Background: Evaluation of real-world data regarding genetic testing for metastatic colorectal cancer (mCRC) highlights the successes and challenges of precision medicine. Guidelines recommend genetic testing to inform mCRC treatment choice. However, there is a lack of real-world evidence regarding genetic testing patterns, including adoption and efficiency. Methods: This retrospective analysis identified adult patients with newly diagnosed mCRC (2015-2106), Medicare Advantage coverage with a pharmacy benefit (MAPD), and claims evidence of CRC-related genetic testing. Inclusion required diagnosis of colon/rectal cancer on ≥2 medical claims and new metastatic disease. Paid and unpaid claims identified genetic testing, which was classified as limited RAS, extended KRAS/NRAS, limited + extended, and BRAF. Efficiency was measured as time-to-testing and time-to-treatment once testing was performed. Results: The study included 4,408 patients with mCRC and MAPD, with a median age of 72 years. Evidence of limited +/- extended testing was noted for 667 (15.1%) of patients. Of these, 78.3% initiated CRC treatment. Limited, extended, and limited + extended testing was observed for 51.7%, 4.5% and 43.8% of patients, respectively. BRAF was observed for 46.4%, 23.3% and 63.7% of patients with limited, extended, or limited + extended testing, respectively. For the 69.2% of patients tested prior to treatment, the median number of days between mCRC diagnosis and first genetic test was 6 [range: 0-31] days, with 25 [13-46] days between testing and treatment. When treatment preceded testing, the median number of days from treatment to test was 72.0 [20-251]. Of patients with > 1 genetic test, most patients had all tests on the same day (96.9%) or within 7 days (97.8%) of diagnosis, with no differences by type of testing. Conclusions: Per guidelines, mCRC-related genetic testing was completed efficiently after diagnosis and prior to treatment initiation for most patients. Genetic testing rates remain low, perhaps indicating barriers to scaling precision medicine. Ongoing research to explore ways to expedite adoption of precision medicine, while maintaining its efficiency, is needed.
Enhanced compliance with appropriate antiemetic prescribing guidelines by utilizing a medically integrated pharmacy antiemetic therapeutic interchange protocol.
Authors: Wilfong Lalan S. , Portnoy Carla , Hoverman J. Russell , Wallace Kathryn , Schwartz Jim R. , Dave Neal , Mikan Sabrina Q. , Patt Debra A. 
Published: September 2018

55 Background: Appropriate antiemetic prescribing remains an unmet need in patients receiving emetogenic chemotherapy. Non-compliance with standard antiemetic guidelines is well reported, and a focus of the American Society of Clinical Oncology Choosing Wisely campaign. Using our medically integrated pharmacies, a community oncology practice sought to maximize compliance with national guidelines by minimizing the use of NK1 inhibitors for low and minimally emetogenic regimens and optimizing medications for highly emetogenic regimens per NCCN guidelines. Methods: A retrospective review of a medically integrated pharmacy antiemetic therapeutic interchange policy. Trained oncology pharmacists imbedded within 2 cancer centers evaluated all new chemotherapy orders to determine the level of emetogenicity per NCCN guidelines. Pharmacists then used a guideline compliant prespecified therapeutic interchange protocol to adjust the antiemetic medications. Patient education to enhance medication compliance was performed by the pharmacists, nurses, and in one on one treatment review sessions with an advance practice provider. Results: Of 271 low to minimally emetogenic regimens, 99% did not receive an NK1 inhibitor on the first cycle. Of 367 highly emetogenic regimens, 97% appropriately received guideline based therapy. Additionally, the use of olanzapine was non-existent in the practice prior to this protocol and increased to 55% of patients with highly emetogenic regimens. Conclusions: We demonstrated that a therapeutic interchange policy with a medically integrated pharmacist shows enhanced compliance with guideline based antiemetic medication usage. This system also allows rapid uptake of changes in supportive care guidelines such as rapid adoption of olanzapine. Efficacy results of this protocol will be reported separately.
Predicting acute care use following the initiation of systemic therapy for solid tumors.
Authors: Grant Robert C , Moineddin Rahim , Yao Zhan , Powis Melanie Lynn , Croxford Ruth , Grunfeld Eva , Kukreti Vishal , Krzyzanowska Monika K. 
Published: September 2018

6 Background: Emergency department (ED) visits and hospitalizations are undesirable and costly. We developed and validated the PROACCT (PRediction Of Acute Care use during Cancer Treatment) score to predict at least one acute care visit during the first 30 days (AC30) after initiating systemic therapy for cancer. Methods: Using administrative data, we identified patients in Ontario with the 18 most common solid tumors who started systemic treatment from July 1, 2014 to June 30, 2015. Southwestern and Northeastern Ontario formed the development and validation cohorts, respectively. We created a score to predict AC30 using multivariate logistic regression in the development cohort. Combinations of tumor sites and regimens were grouped into quintiles based on AC30. The score was assessed in the validation cohort. Results: AC30 occurred in 23% (4438/19359) of patients. Eleven factors predicted AC30 and formed the score: tumor site and regimen (2nd quintile: 2; 3rd-4th: 3; 5th: 4), recent ED visit (2), recent palliative radiation (1), rural residence (1) and Edmonton Symptom Assessment Scale anxiety (4+: 1), lack of appetite (4+: 1), pain (4+: 1), and wellbeing (4+: 1). Among the 204 tumor-regimen combinations, tumors with poor prognoses, such as pancreatic and lung, and platinum- and taxane-containing regimens, carried the highest risk for AC30. The score had moderate discrimination (c-statistic 0.65; P< 0.001) and strong calibration (Table) in the validation cohort. Conclusions: PROACCT identifies factors that predict AC30 in patients starting systemic treatment for solid tumors and could be incorporated into electronic health records to select patients for preventative interventions. [Table: see text]
Burdensome transitions on cancer decedents treated in different health care systems at the end of life.
Authors: Gidwani Risha 
Published: September 2018

7 Background: Cancer decedents often experience intensive and unnecessary medical care in the months prior to death. We evaluated whether cancer patients treated by a purchasing system with fee-for-service incentives (Medicare) experience a greater number of burdensome transitions in the last 6 months of life compared to those treated by a system in which care is directly provided by salaried clinicians (Veterans Health Administration, or VA). Methods: We evaluated Fee-for-Service (FFS) Medicare and VA data from FY 2010-2014 for the population of veteran cancer decedents who died from solid tumor, as assessed by National Death Index data (n = 97,955). Burdensome transitions were defined as ED visits or hospital admission in the last 6 months of life. Veterans were allocated to the system (i.e., Medicare, VA) in which they received the most overall healthcare. We modeled outcomes using hierarchical logistic regression, with month nested within patient. Models adjusted for variables previously shown to influence veteran selection into Medicare versus VA, comorbidity burden, and time trends. Results: In adjusted analyses, veterans treated by Medicare were significantly more likely to experience an ED visit in the last 6 months of life compared to veterans treated by VA (aOR = 1.37, 95% CI 1.26-1.49, p < 0.001). Adjusted analyses also revealed veterans treated by Medicare were significantly more likely to experience a hospital stay in the last 6 months of life compared to veterans treated by VA (aOR 1.28, 95% CI 1.17-1.40, p < 0.001). Conclusions: Patients dying of metastatic solid tumor who were treated under FFS Medicare were more likely to have ED visits or hospital stays in the last six months of life those treated by VA. As VA shifts more towards purchasing care in the community for its veterans, they may be at greater risk of experiencing burdensome transitions in the last months of life.[Table: see text]
A review of oncologic therapeutic phase III clinical trial literature: Exploring the reporting of clinical trial data of older patients with cancer.
Authors: BrintzenhofeSzoc Karlynn , Shahrokni Armin , Canin Beverly E. , Parker Ira Russell , Krok-Schoen Jessica L. , Koll Thuy , MacKenzie Amy R. , Lund Jennifer Leigh , Hsu Christine D , Pan Kathy , Vankina Ritika 
Published: September 2018

70 Background: With demographic shifts leading to an aging cancer population, the American Society of Clinical Oncology (ASCO) has recommended that journal editors improve the reporting of clinical trial data specific to older adults. This study aimed to assess the current reporting status of clinical trial data regarding older adults with cancer. Methods: This was a review of oncologic therapeutic phase-3 clinical trial data published from 07/01/2016-06/30/2017. Based on a keyword search of EMBASE and PubMed, 929 manuscripts were identified. Removing duplicates (n = 116) and articles that did not meet this study’s cancer inclusion criteria (n = 589), a total of 224 were identified. In the pilot phase there was 85% agreement among the reviewers. Results: Thus far, 197 papers (88%), have been independently reviewed with 118 evaluated by more than one reviewer. Reviewed papers were published in 57 journals including Journal of Clinical Oncology (28, 14.2%), Lancet Oncology (25, 12.7%), and NEJM (20, 10.2%). Much of the literature focused upon the following cancer sites: Breast (33, 16.7%), Lung (27, 13.7%), Colorectal (18, 9.1%), and Prostate (12, 6.1%). 175 articles included inclusion/exclusion criteria, 32 (16.2%) had upper age exclusion criteria. Age was presented in 184 articles and data was stratified by age in 84 (42.6%). Age stratification of effectiveness and toxicity were presented in the results section in 65 (38.2%) and 21 (14.4%). Effectiveness by age was in the discussion section in 37 (18.8%) and toxicity by age in 16 (8.1%). Reviewers could not determine the proportion of study participants who were older adults in 111 articles (56.2%). In the remainder of the articles, the proportion ranged from 0% to 81%, except one in which all participants were older adults. Conclusions: A slim minority of phase-3 oncologic clinical trials included and discussed age-referenced results regarding the effectiveness and toxicity of treatments in older adults. Clinical investigators and journal editors should consider the ASCO recommendation and increase the reporting of oncologic clinical trial data specific to older adults.
Using ASCO QOPI and the QTP as an improvement model in a small safety net cancer center.
Authors: Simmons Crystal , Power Steve 
Published: September 2018

78 Background: Organizational change is challenging in a well-resourced large academic cancer center. Such challenges are greater in a resource-constrained safety net cancer center. This project sought to learn how the combination of ASCO QOPI data submission and the Quality Training Program (QTP) could assist JPS with implementing a quality improvement project. Methods: The results from QOPI data submissions for Fall 2016 and Spring 2017 indicated opportunity in the area of oral chemotherapy education. This was prioritized due to increasing use of oral chemotherapy and relatively poor adherence data nationally 1,2. The team recognized the relatively low sample size in the QOPI results and supplemented the data with additional abstraction to validate the original hypothesis. Following the structure provided by the QTP enabled JPS to focus its limited resources on understanding the existing process and formally interrogating it to determine the key causes of the problem. Additional information was obtained from the provider team via the use of an online survey. The team found that no single intervention would achieve the goals of improving the metric to above the QOPI mean they implemented small changes over time. These included reducing variation in ordering processes by defaulting to an electronic method; adding the Via oral chemotherapy protocols to the EMR; and developing and deploying a pre-chemotherapy checklist. The team learned that continual reinforcement and inquiry was necessary to ensure the effectiveness of some interventions. Results: Post-implementation results revealed improvements beyond the targeted measure. Approaching the problem systematically and methodically deploying solutions, the team observed improvements in multiple related oral chemotherapy QOPI measures. Conclusions: Meaningful change can result from the ASCO QOPI data and QTP combination in a safety net cancer center. Projects need to start small and remain focused. Challenges to implementing QI in a resource limited environment remain; however, these can be addressed with a methodical approach and strong support from leadership.
Opportunities for improving cancer care management through primary care-oncology relationships.
Authors: Tsui Jennifer , Howard Jenna , Miller William L. , O'Malley Denalee M. , Hudson Shawna V. , Rubinstein Ellen , Bator Alicja , Crabtree Benjamin F 
Published: September 2018

80 Background: Improvements in the management of care transitions between primary care and oncology are critical for achieving optimal care quality and outcomes for cancer patients and survivors. We examine relationships between innovative PC practices and oncologists to inform and strengthen PC-oncology interfaces in diverse healthcare settings. Methods: Comparative case studies of 14 innovative PC practices throughout the United States examined strategies for providing cancer survivorship care. Field researchers observed each practice for 10-12 days, recording fieldnotes and conducting key informant and formal, semi-structured interviews with clinicians and staff. We extracted all data related to PC-oncology relationships and then collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results: Nine of the 14 practices discussed either formal or informal PC-oncology relationships. Nearly all practices with existing formal PC-oncology relationships were embedded within healthcare systems. Private, independent practices had more informal relationships between individual PC physicians and specific oncologists. Practices with formal relationships noted ease of communication and transfer of patient information, timeliness in patient referrals, and direct access to oncologists; while practices with informal relationships noted the benefits of having close engagement with specific oncologists. Regardless of relationship type, remaining challenges include lack of clarity about roles during cancer treatment and beyond. Conclusions: With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate the strengths of both formal and informal PC-oncology relationships to improve care for cancer patients and survivors.