bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving communication with referring oncologists (RO): Indiana University experience.
Authors: Hashemi-Sadraei Neda , Kalra Maitri , Gbolahan Olumide B. , Betbadal Anthony Michel , Grethlein Sara 
Published: September 2018

276 Background: Poor communication between referring physicians and consultants can lead to disruptions in continuity of care, unnecessary testing, and iatrogenic complications. We sought to identify the barriers to effective communication between Indiana University Simon Cancer Center (IUSCC) oncologists and ROs. Methods: We retrospectively analyzed communication surrounding the visits of consecutive new oncology patients (pt) to IUSCC during Dec 2017 and Jan 2018. Demographics, diagnoses, RO’s information, and IUSCC physician’s information were recorded from the electronic medical record (EMR). ROs were contacted and a questionnaire was administered about timeliness, methods, and satisfaction with the communication. Results: A total of 110 new pt consultations were undertaken during the study period. There were 9 self-referrals, 69 interfacility referrals from the IU Health system, and 32 referrals by community RO. We were able to reach 27 community ROs, and their comments were included in the final analysis. RO interviews revealed that 78% had received notes (21 of 27 visits). Median time from pts’ clinic visit at IUSCC to ROs receiving a note was 2.5 days (range, 0-38 days). Five (25%) notes were received on the same day of consultation, and 10 (50%) were received within 2-7 days from pt visit. Of 18 traditionally dictated notes, 16 (89%) were received by ROs. Of 9 EMR typed notes, 5 (55%) were received by ROs. Only 62% of ROs received notes when their information was missing in the EMR. Based on feedback from ROs, effective communication was defined as communication within 7 days from pt visit. Ineffective communication was seen mostly on Mondays, followed by Fridays (75% and 50%, respectively). Conclusions: Effective communication was achieved in 75% of consultations. Effective communication was impacted by the day of the week, accuracy of RO information in the EMR, and the method of note documentation. Correcting ineffective communication can be explored through improvement of both human factors (ex.reinforcement of timely communication goals with physicians) and system factors (ex. Improving the accuracy of RO data in the EMR). Checklists, audits and other process analytics may help overcome the barriers identified.
Hospital variation in outcomes after surgery for prostate cancer.
Authors: Hassett Michael J. , Mossanen Matthew , Weng Shicheng , Cronin Angel M. , Uno Hajime , McNiff Kristen K. 
Published: September 2018

28 Background: Surgery for prostate cancer can lead to adverse outcomes, such as incontinence and erectile dysfunction. Studies have identified hospital variation in survival after surgery for other types of cancer; few studies have assessed hospital variation in outcomes after prostate cancer surgery. We sought to characterize hospital variation in incontinence/erectile dysfunction (IED) and overall survival (OS) after prostate surgery. Methods: Using SEER-Medicare claims, we identified men > 65 years old who had surgery for prostate cancer from 2009-13, excluding those with metastatic disease, chemotherapy, or radiation therapy. We computed the difference in the number of days with claims for incontinence or erectile dysfunction in the year after versus the year before prostate surgery (IED score). Then, we assigned each patient to the hospital where prostate surgery was performed, and derived the mean IED score for hospitals that treated ≥10 patients (n = 239). Hierarchical linear and cox regression models were used to assess the association of patient, tumor, and hospital factors with the IED score and OS, respectively. The Kaplan-Meier method was used to estimate 3-year OS. Results: Among 10,850 Medicare-insured men with prostate cancer, the mean difference in claim-days for incontinence or erectile dysfunction during the year after versus before prostate surgery was +2.34 (standard deviation [SD] 3.72, minimum -18, maximum 54). After rescaling the IED score using a 0 (worst) to 100 (best) scale, the mean unadjusted hospital performance was 52.7 (SD 8.0). Controlling for other factors, hospital, NCI-cancer center designation (comprehensive vs. none), region in the US (south or west vs. northeast), and type of prostate surgery (open vs. not) were associated with a higher IED score. The mean 3-year OS across all hospitals was 98% (SD 3%). Conclusions: This claims-based analysis identified significant variation in incontinence/erectile dysfunction after prostate cancer surgery by hospital, but not by patient socio-demographic factors. The IED score may help identify opportunities to improve outcomes. Efforts to validate claims as indicators of patient-centric outcomes and to explore the reasons for hospital-level variation are needed.
Strategies for reducing grade 2 and 3 adverse events due to immunotherapy in a Spanish university hospital.
Authors: Gomez Ana , Gómez Solana Paloma , Ruiz Elena , Anton Antonio , Aranda Enrique , Camps Carlos , Constenla Manuel , Cruz Juan Jesús , Díaz Rubio Eduardo , Feyjoo Margarita , García Foncillas Jesús , Gascon Pedro , Guillem Vicente , Lopez Rafael , Lugo Ilse , Carrato Alfredo 
Published: September 2018

288 Background: To develop an improvement project, the Lung Cancer Unit of Ramón y Cajal Hospital (Madrid) analyzed 45 patients treated with immunotherapy in 2017 and detected that 55% presented moderate-to-severe Adverse Events (AEs). Consequently, a specialized team from Ramon y Cajal Hospital and ECO Foundation proposed to identify improvement areas that reduce grade 2 (G2) and 3 (G3) AEs. ECO is a collaboration of experts representing the major Spanish hospitals in the pursuit of excellence in cancer treatment. Methods: The team used as an instrument the American Society of Clinical Oncology (ASCO) Quality Training Program (QTP). A data collection process was conducted before attending the first out of three sessions of the QTP with the revision of medical records from lung cancer patients. The goal for the final QTP session in late-June 2018 was to reduce G2 and G3 AEs by 25%, by standardizing patient education sessions using ASCO guidelines for the management of immune-related AEs. Results: The data collected showed that G2 and G3 AEs had an impact on quality of care, specifically a treatment delay in 31% of patients, unscheduled visits in 19%, serious complications in 11% and patient dissatisfaction with the reporting system. The team created a cause and effect diagram, in which the most relevant causes were inadequate patient knowledge and a lack of communication with patients between visits, in addition to a Pareto chart, in which the more frequent AEs were asthenia, respiratory infection, cough, among others. A run chart of percentage of G2 and G3 AEs during 2017 displayed that G2 AEs were higher during January and August; and G3 AEs in February and December. The team, including patient advocates, prioritized the implementation of these short-term measures for patients: improvement of education, education follow-up, satisfaction questionnaire development and AE knowledge test. By mid-June 2018, new data will be collected to determine the effectivity of these measures. Conclusions: This improvement approach indicates the need to continue further quality projects in healthcare. Broader participation of Spanish hospitals in improvement initiatives will enhance the goal of a quality-oriented health care system.
Oral chemotherapy adherence tracking program implementation at a medically underserved comprehensive community cancer center.
Authors: Chandra Abhinav Binod , Sweigart Mary , Alvarez Angelic , Kumar Vivek 
Published: September 2018

294 Background: The field of oncology has witnessed a significant increase in the number of oral antineoplastic agents over the last several years and their utilization is expected to grow. Several deficiencies in procedures for safe management and monitoring of oral chemotherapy regimens remain unaddressed. Rates of adherence to oral antineoplastic agents have varied in literature and not widely studied. There is paucity of data on impact of oral chemotherapy adherence to patient outcomes or emergency room visits. Methods: Baseline oral chemotherapy adherence was tracked in new oral treatment plans. This was supplemented with education of staff to run reports and increase chemotherapy tracking with special focus on education and follow ups. Over 9 month period, the oral chemotherapy tracking process was implemented with the goal of 80% tracking being achieved. Emergency room (ER) visits were calculated on patients having active oral chemotherapy care plans during a 3-month period before and after implementation of the program. Results: Reporting metric for compliance with oral tracking showed improvement from 5% completed reports to 84% completed reports over 9 months. The goal set to achieve 80% tracking was reached. The program was successfully implemented from January 2017 – September 2017. Prior to implementation of the program, over a 3-month period, 55 patients were receiving active oral chemotherapy care, with 56 encounters of ER visits by 30 patients related to their cancer. After successful implementation of the program and with consistent 80% chemotherapy tracking in place, we analyzed data for another 3-month period. During this 3-month period, 108 patients were receiving active oral chemotherapy, with 31 encounters of ER visits by 17 patients for their cancer. Conclusions: Implementation of a tracking program for oral chemotherapy led to 72% reduction in emergency room visits by patients on oral chemotherapy care plans. We were successfully able to implement an oral chemotherapy adherence tracking program in a medically underserved comprehensive community cancer program. A prospective study can further validate the findings of this study.
Building a cancer registry performance dashboard by leveraging existing workflow documents at a comprehensive cancer center.
Authors: Yakowec Jing Jing Wang , Stendhal Ingrid , Lakhani Hakim , Jacobson Joseph O. 
Published: September 2018

296 Background: Quantifying the performance of a cancer center’s cancer registry is important to plan for resources needed to address shortcomings and projected increases in workload. The objective of this project was to understand the workflow, reporting requirements, and existing documentation of the cancer registry at Dana-Farber Cancer Institute (DFCI) in order to build a dashboard that quantifies monthly performance. Methods: Current state workflow maps were created detailing the three phases of the cancer registry’s operations: case finding, case abstraction, and case follow-up. Individual meetings and a workshop with the cancer registry staff were held to validate workflows, gather operational challenges and improvement ideas, and set performance metrics. Leveraging information already being collected by staff as part of their workflow, a database was designed to collect and auto-visualize monthly performance using Excel and Tableau. Results: The performance dashboard shows monthly trends of ‘on target’ status of the cancer registry’s case finding, case abstraction, and case follow-up efforts. It also quantifies how delayed the cancer registry is in case finding or abstraction and provides new case count trends by care facility, staffing capacity based on case load, and trends in lost to follow-up patients. One hundred percent of the performance dashboard data is from documentation already generated by the cancer registry staff on a routine basis. Data on monthly case load from September 2017 through March 2018 are presented in the table below; given a maximum limit of 86 cases to abstract per abstractor per month, the cancer registry is currently at more than full capacity. Conclusions: A well-designed cancer registry performance dashboard that leverages existing data does not add burden to registry staff and informs how best to manage and utilize resources according to case load. [Table: see text]
Clinical pathway creation and adherence at a large hybrid cancer center.
Authors: Carnell Matthew , Fleming Martin D. , Portnoy David Craig , Ballo Matthew T. , Fisher Kristopher , Somer Bradley G. , Tauer Kurt W. , Prince Cheryl A. , Vanderwalde Ari M. 
Published: September 2018

298 Background: Clinical pathways are valuable in reducing treatment variation, improving outcomes, and reducing costs in an oncology setting. With input of clinical stakeholders at West Cancer Center, we created and implemented a melanoma clinical pathway to improve care and facilitate standardization between melanoma sub-specialists and general oncologists. Retrospective pathway adherence was assessed to inform quality improvement goals. Methods: Using national guidelines and expert literature review, we developed a pathway defining a center-wide algorithmic approach to treat melanoma. Prior adherence to the pathway was retrospectively assessed by evaluating treatment during 1 year across 8 metrics. All patients who received systemic melanoma therapy during the study period at a large cancer center ( > 5000 new patients annually) were included in the assessment. Of the included patients, metric adherence was only measured when applicable. Adherence rates were described for predefined melanoma subspecialists versus predefined general oncologists without a declared subspecialty in melanoma. Significance was assessed with fisher exact test. Results: The following metrics were defined by the expert team as essential components of melanoma pathway; receipt of wide local excision; receipt of sentinel lymph node biopsy; presentation at multidisciplinary conference; molecular profiling before treatment of metastatic disease; treatment with preferred regimens in 1st line, 2nd line, and 3rd line; and clinical trial participation. Ninety patients were evaluated. Conclusions: Most differences in pathway adherence were found to be not significant. Clinical trial accrual was higher among melanoma subspecialists compared to general oncologists. Clinical pathways allow patients treated by general oncologists to benefit from the expertise of subspecialists and improve quality of care.[Table: see text]
Implications of short-term follow-up tomosynthesis mammography on downstream workup after breast conservation therapy.
Authors: Weinberger Kevin , Colosimo Brittany , Hasan Shaakir , Gresswell Steven , Anderson Sidney , Wegner Rodney E , Trombetta Mark G. 
Published: September 2018

311 Background: We previously reported that premature (less than 6 months) follow-up screening mammography after radiotherapy in breast conservation therapy was associated with an increased rate of unnecessary downstream workup. We now present the results of a similar study conducted with follow-up tomosynthesis mammogram (TS). Methods: Between the years 2015-2017, 143 consecutive breast cancer patients between ages 33 – 82 were treated with lumpectomy and adjuvant radiotherapy with follow-up TS and reviewed in this IRB-approved study. Cases were stratified by time interval until the first post-radiation TS, and secondarily by radiation technique: conventional fractionation (n = 84), hypofractionation (n = 59), boost (n = 116), no boost (n = 27), and accelerated partial breast irradiation (n = 10). The primary endpoint was the rate of further imaging/workup following TS, correlated with clinical, treatment, and post-treatment timing related variables using multivariable binomial regression analysis. Results: The patient cohort included the following clinical characteristics: 6 patients with ductal carcinoma in-situ (the remaining demonstrated either invasive ductal or invasive lobular histology), Ninety-seven patients had stage T1 lesions, 34 had T2, and 4 had T3/T4 lesions. Eighteen patients were node+, 95 ER+/ Her2-, 13 were triple negative, and 13 triple positive. No patients had clinical suspicion of recurrence before their first follow-up TS. Conclusions: Unlike with post-treatment screening two-dimensional mammography, there was no association with post-treatment tomosynthesis timing and downstream workup. Further study should be considered to confirm these preliminary findings.
Reducing inappropriate rasburicase use to promote cost-effective care.
Authors: Gupta Arjun , Patel Komal , Roberts Taylor , Marley Eileen M. , Li Hsiao Ching , Sadeghi Navid 
Published: September 2018

312 Background: Rasburicase is recommended for treating established Tumor lysis syndrome (TLS) and patients at high-risk for TLS. Unfortunately, it is an expensive medication and unnecessary use contributes to expenses. Methods: A multidisciplinary quality improvement team reviewed the process of ordering rasburicase and its prescription patterns at Parkland Heath and Hospital System, Dallas, TX between 10/2015-9/2017. Use was determined as appropriate/ inappropriate based on internally approved indications (laboratory TLS, at-risk for TLS, acute kidney injury and hyperuricemia, failure of or inability to administer allopurinol). Quality improvement interventions were implemented based on weaknesses identified. Results: 65 doses of rasburicase were administered during the 2-year baseline period; 21 (32.3%) of these were grossly inappropriate. The most common ordering providers were oncologists (23 orders, 35%), hospitalists (16 orders, 25%), intensivists (11 orders, 17%), and emergency physicians (8 orders, 12%). Ordering process review identified several pitfalls: one-click ready to sign order, auto-population of dosage, no hard-stop requiring providers to review rasburicase indications, and no pharmacy oversight. We aimed to reduce the percentage of inappropriate rasburicase orders from a baseline of 32.3% to 10% over 3 months. In 2/2018, we implemented PDSA cycle 1 including introducing a best practice advisory requiring providers to select an approved indication for medication use and changed auto-population of rasburicase dosage to 3 mg. A mandatory secondary review by pharmacy prior to dispensing the medication was implemented. Over a 3-month period post-change (2/2018- 5/2018), 11 of 11 rasburicase administered doses have been appropriate (0% inappropriate). Conclusions: A multidisciplinary team and classic quality improvement methodology was able to reduce inappropriate rasburicase use from 32.3% to 0%, with significant cost savings. Straightforward electronic medical record interventions and increased pharmacy oversight are effective interventions in curbing medication overuse. We will periodically re-assess utilization patterns and refine PDSA cycles as needed.
Development of a drug-drug interaction screening tool for oncology clinical trial enrollment.
Authors: Marcath Lauren A , Coe Taylor D , Redman Bruce G. , Hertz Daniel Louis 
Published: September 2018

315 Background: Screening drug-drug interactions (DDI) for subjects enrolling in oncology clinical trials is critical to ensuring patient safety and the validity of clinical trial data. We previously reported that DDI screening is not uniformly conducted when screening patients for enrollment into SWOG clinical trials and found that at the University of Michigan Rogel Cancer Center up to 24.2% of subjects enrolled in National Clinical Trial Network (NCTN) trials had a DDI. Screening tools aid in DDI reduction in clinical practice, but none have been created for clinical trial enrollment. Our objective was to develop a clinical trial specific DDI screening tool based on features requested by the end-users of the tool at U-M. Methods: Semi-structured and informal interviews were conducted with all data managers who enroll patients into NCTN clinical trials at the U-M cancer center. Data managers were asked about their current workflow and desired features of a DDI screening tool. Responses were combined and reviewed for feasibility. Desired features were conveyed to PEPID, LLC (Phoenix, AZ) for tool development. Results: Four data managers were interviewed. Protocol-guided screening was a key workflow feature, which was completed by gathering DDI information primarily from the exclusion criteria and drug information sections of each respective protocol, Google, CredibleMeds, and the Indiana University P450 Drug Interaction Table. Consequently, a critical feature was the display of drug characteristics with wording that aligned with that in the protocol including transporter and CYP450 substrates, inhibitors, or inducers and QT prolongation potential. Additional desirable features included separate entry of study and concomitant drugs, filtering to display only DDI with study drugs, and PDF export of results. PEPID developed a prototype tool including these desired attributes for a prospective implementation pilot study. Conclusions: A first generation clinical trial specific DDI screening tool was developed based on end-user feedback. We are designing a prospective study to determine whether implementation of this tool can reduce DDI, enhance patient safety, and ensure validity of clinical trial data.
Automated quality control process for tracking appropriateness of antiemesis.
Authors: Cheema Naveed R. , Master Samip R. , Mansour Richard P. 
Published: September 2018

317 Background: Quality tracking and improvement are areas of importance for delivery of high value patient care. Quality Oncology Practice Initiatives (QOPI) are tools designed by ASCO to help oncology practices deliver high quality care. Specifically, QOPI measure 29 tracks whether antiemetics are administered appropriately with moderate/high emetic risk chemotherapy. In this study, we attempted to automate this quality measure using an adapted Microsoft Structured Query Language (SQL) procedure. Our primary aim was to develop an efficient and cost effective system to track appropriate anti emesis that is adaptable to other cancer centers. A secondary aim was to quantify any degree of over treatment in anti emesis in our center. Methods: We created an SQL procedure which accessed the EPIC CLARITY database and used 9 steps to identify how many chemotherapy administrations in our center for the year 2017 were given sufficient, over, or under anti emesis. We adapted our center’s antiemesis guidelines from 2017 ASCO Clinical Practice Guideline Update for antiemetics. The program identified “pass”/”fail”/”pass(-)” for appropriate/insufficient/over treatment of anti emesis, respectively. Results: 1490 patient/chemotherapy encounters were found for 2017. 862/118/510 were high/intermediate/low emetic risk, respectively. 1314/14/162 chemotherapy administrations received “pass”/”fail”/”pass (-)”, respectively. The reason for 13 of 14 “fails” was lack of steroid in high emetic risk regimens. The primary reason for “pass (-)” was use of fosaprepitant in low/intermediate risk regimens. The time required to execute the program for all 1490 encounters was 40 seconds; the average time for manual review was 3 minutes per encounter. There was no discordance between “pass/fail” status in comparing automated and manual reviews. Conclusions: We have created an automated process which rapidly and accurately verifies adherence to QOPI measure 29. It eliminates time and costs associated with manual review. Further, this program saves costs by identifying areas of over treatment in anti emesis. We have demonstrated on a large scale an adaptable and shareable process for other centers using similar EMR databases.