bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peer review in radiotherapy (RT): A national quality improvement initiative.
Authors: Brundage Michael Donald , Bass Brenda H , Foxcroft Sophie , Halperin Ross , McGowan Thomas , Milosevic Michael F. , Parliament Matthew , Warde Padraig Richard ,   The National Peer Review Initiative Steering Committee
Published: February 2017

221 Background: Peer review (PR) in Radiation Oncology has been shown to be effective in improving quality of treatment by detecting and correcting deficiencies in proposed treatment plans prior to treatment. PR is also effective in: guiding departmental treatment planning policies and processes; reducing variation in practice; providing a venue for multi-disciplinary communication, and increasing staff and trainee awareness of evolving treatment processes. The importance of PR is reflected in the inclusion of 3 PR-specific quality indicators in the Canadian Partnership for Quality Radiotherapy QA Guidelines for Radiation Oncology programs. Given this endorsement, we aim to enhance PR implementation across all Canadian cancer centres using a knowledge-translation and implementation framework. Methods: This project will facilitate increased uptake of PR in Canadian RT programs by implementing the top-down model used with success in Ontario. This model has several key components, including: a) engaging the leadership of provincial cancer agencies to promote PR at every Provincial cancer centre; b) providing modest financial support for the acquisition of the required hardware and/or staff time for coordinating PR activities; c) systematic collection of each centre’s baseline PR activities, perceived barriers and potential facilitators of PR at each centre; d) creation of a continuous quality improvement cycle by monitoring PR quality indicators over time; e) systematic knowledge and information sharing regarding effective PR processes. Results: Funding for this initiative was obtained from the Canadian Partnership against Cancer (CPAC) in April 2014. A steering committee consisting of stakeholders from across Canada has been struck and provincial launches, based on the tenets used in Ontario, have commenced in 7 of 13 provinces with others expressing interest. A national survey to obtain baseline data relating to PR activities, perceived barriers, and facilitators is underway and will be reported. Conclusions: Preliminary evidence suggests a “snowball effect” of increasing PR uptake across Canada. The implementation model could be applied in other jurisdictions interested in increasing PR in radiation oncology.
Data accuracy and financial cost of conducting retrospective ontological clinical trials using ICD-9-CM in the age of ICD-10-CM.
Authors: Shergill Ardaman , Dorestani Parvaneh , Boyd Andrew D. , Venepalli Neeta K. 
Published: February 2017

229 Background: Estimates of the 1 year implementation delay of ICD-10-CM (I10) range upto $6.6 billion with the majority of cost attributable to I10 implementation. Little attention has been paid to post implementation costs and management strategies for data accuracy within longitudinal cancer related databases spanning both ICD-9-CM (I9) and I10. The objective of our study was to quantify financial impact and compare data quality of I10 transition in cancer clinical trials through backward I10 to I9 mapping via two tools. Methods: Cancer related original research articles published in NEJM, Blood and JCO between Jan 1st 2013 and Dec 31st 2013 were reviewed for I9 utilization. Each I9 code was mapped forward to I10 via the Motif web portal tool. The I10 codes were manually reviewed with additional clinically relevant I10 codes added. The final I10 code list was mapped backward to I9 using two tools, the Motif web portal and CMS GEMs. Generated I9 codes were compared to the original I9 list to identify ‘lost’ codes. To assess financial implications of lost data, lost I9 codes were assessed in 2010 Illinois Medicaid data. Results: Of 1,567 original articles reviewed, 7 articles were included and yielded 412 I9 codes which mapped to 1437 I10 codes. Upon manual review, 416 I10 codes were added. Backward mapping by Motif web and CMS GEMs respectively yielded 652 and 551 I9 codes; 16 of the original I9codes were absent from the CMS GEMs list while Motif tool yielded 100% of original codes. Of these 16, 12 codes were present in 2010 Illinois Medicaid data, and accounted for 7,490 patient encounters (0.52%) and $1.1 million (0.35%) of total Medicaid reimbursements. Conclusions: We report significant differences in data quality of I9 generated by backward coding via CMS GEMs and the Motif web tool, with major financial impact. Longitudinal data analyses upto 5 years post ICD-10-CM transition will require backward coding, and comparison of ICD-9-CM codes for accuracy. The bridging methodology and analytic tools presented can be replicated by organizations and clinical researchers to increase data fidelity spanning the upcoming transition.
Improving the patient experience for cancer patients in Ontario through real-time measurement.
Authors: Kraetschmer Nancy , Glazer Alysha , Green Esther , Macdougall Laura , Singh Simron 
Published: February 2017

240 Background: Cancer Care Ontario (CCO) is an Ontario government agency that drives system wide quality improvement in disease prevention and screening, the delivery of care and the patient experience (PE), for cancer, chronic kidney disease and access to care for key health services. CCO partners with 14 Regional Cancer Programs across the province. CCO measures the cancer PE retrospectively through a paper-based Ambulatory Oncology Patient Satisfaction Survey but there are limitations such as the delay in reporting of results. CCO is developing and implementing a province-wide electronic real-time PE survey to measure PE. An electronic survey tool will enable the collection, analysis and reporting of PE data more quickly to drive quality improvement. Methods: A current state assessment was undertaken in fall 2013 to understand support for and readiness of CCO’s Regional Cancer Centres (RCCs) to move forward with measuring PE in real-time, at point of care. 14 semi-structured interviews were conducted with RCCs Regional Vice Presidents (RVP); over 800 patients participated in focus groups in 11 of 14 regions; a targeted online survey was completed by 16 administrators in 14 regions. Results: Interest in a real-time measurement (RTM) approach was overwhelmingly positive – 94% of patients and 100% of RVPs thought that measuring PE in real-time is important. Patients want the real-time survey to be short - 61% of patients reported that the number of questions they are willing to answer is 5-10, with 18% indicating 15 questions. 62% of patients reported that they were willing to spend 2-6 minutes answering a survey, with 24% reporting 10 minutes. 36% of the RCCs have ad hoc RTM strategies and 21% have utilized an electronic tool. There was no co-ordination or data sharing between RCPs. Conclusions: CCO is implementing a province-wide RTM strategy which includes the validation of a RTM PE survey and procurement of an electronic solution to capture, analyze and report PE data. CCO will initially pilot the survey and electronic tool with the intention of a provincial rollout to cancer centres upon a post-pilot evaluation.
The cancer imaging program quality framework at Cancer Care Ontario: The first five years.
Authors: Dobranowski Julian , Melamed Saul , Langer Deanna , Bedford Colleen 
Published: February 2017

244 Background: The Cancer Imaging Program (CIP) at Cancer Care Ontario was established in 2009 to improve the quality of cancer imaging in Ontario. Methods: After initial selection of a Provincial clinical lead in 2009, fourteen regional clinical leads were selected to represent all geographical regions of the province. Through a stakeholder survey and a priority setting process the following four high-level areas of priority emerged to support quality improvement of cancer imaging: (1) Developing and Fostering an Imaging Community of Practice, (2) Imaging Appropriateness, (3) Timely Access to Imaging, and (4) Standardized/Synoptic Reporting. Results: (1) An Imaging Community of Practice was established with the regional clinical leads, who participate in monthly meetings to build and strengthen inter-regional relationships and share information on regional activities and priorities; (2) Best practice standards for imaging in lung and colorectal cancer have been developed by consolidating and endorsing national and international guidelines. New imaging guidelines are being developed by the Program in Evidence-Based Care. Evidence-based recommendations being developed for focal tumour ablation procedures; (3) Three Interventional Radiology procedures (CT-guided lung biopsies, peripherally inserted central catheters and portacaths) have been selected for an ongoing wait time collection that captures monthly point-in-time data. The data has initiated discussions on appropriate benchmarks and identification of factors that may contribute wait times; and (4) Synoptic Radiology Reporting enables the collection of uniform and complete data to improve the information available to referring clinicians for diagnosis and treatment planning. Work is underway in the development of: implementation roadmap, evidence-based clinical checklists, infrastructure to store and share synoptic reports, and international standards for synoptic radiology reporting. Conclusions: The establishment of the CIP as a clinical program under a provincial cancer agency has enabled the development of an Imaging Community of Practice and allowed for work on provincial-wide initiatives that enable quality improvement of cancer imaging.
Predictors of guideline treatment nonadherence and the impact on survival in patients with colorectal cancer.
Authors: Hines Robert B. , Barrett Alina , Twumasi-Ankrah Philip , Broccoli Dominique , Engelman Kimberly K. , Baranda Joaquina Celebre , Ablah Elizabeth , Jacobson Lisette , Redmond Michelle , Tu Wei , Collins Tracie 
Published: February 2017

254 Background: We investigated the effect of comorbidity, age, health insurance payer status, and race on the risk of nonadherence with National Comprehensive Cancer Network (NCCN) treatment guidelines for colorectal cancer (CRC) patients. In addition, the prognostic impact of NCCN treatment nonadherence on survival was assessed. Methods: Colon and rectal cancer patients who received primary treatment at Memorial University Medical Center in Savannah, GA from 2003 to 2010 were eligible for this study (final N = 679). Modified Poisson regression was used to obtain risk ratios for the outcome of nonadherence with NCCN treatment guidelines. Hazard ratios (HRs) for the relative risk of CRC-related death were obtained by Cox regression. Results: Guideline-adherent treatment was received by 82.5% of patients. Moderate/severe comorbidity, being uninsured, having rectal cancer, older age, and increasing tumor stage were associated with increased risks of receiving nonadherent treatment. Treatment nonadherence was associated with 4.5 times the risk of CRC-related death (HR, 4.53; 95% CI, 2.56-8.00) in the first year following diagnosis and 2.0 times the risk of death (HR, 1.97; 95% CI, 1.20-3.25) in years 2 to 5. The detrimental effect of nonadherence was demonstrated across all levels of comorbidity and age. Conclusions: Although there are medically justifiable reasons to deviate from NCCN treatment guidelines in CRC patients, patients who received nonadherent treatment had much higher risks of CRC-related death, especially in the first year following diagnosis. This study’s results highlight the importance of cancer health services research to drive quality improvement efforts in cancer care for CRC patients. [Table: see text]
Potential pitfalls of binary reporting metrics using a QOPI end-of-life (EOL) sample.
Authors: Barysauskas Constance , Dalby Carole Kathleen , Catalano Paul J. , Jacobson Joseph O. 
Published: February 2017

261 Background: Practice accountability through measurement is emergent in the United States. The National Quality Forum has adopted several EOL metrics as national standards. Care at EOL is highly variable due to patient and family preference, symptom management, and psychosocial care. We hypothesize binary measures with fixed cut-points limit the understanding of EOL practice thus reducing opportunities for care improvement. Methods: We previously demonstrated limitations of the QOPI sampling methodology among all patients at Dana-Farber Cancer Institute Satellites following the QOPI sampling strategy between July 1, 2012 and December 31, 2012. Using the same population, we examined the distribution of chemotherapy administration in the last two weeks of life. We compared our QOPI EOL data (A) with simulated scenarios modeled via log-normal distributions (B, C, D, E). The binary metric was held constant at the observed proportion to illustrate potential variability in other statistical metrics. Results: A total of 193 patients received chemotherapy before death. Chemotherapy administration in the last two weeks of life was measured at 11%, with a mean of 84 days (inter-quartile range, IQR: 92 days). Different distributions were generated by varying the mean and SD as demonstrated in the table below. Conclusions: As our simulated scenarios show, practices disseminating the same binary metric may stem from very different distributions. We have identified two limitations of binary reporting metrics with fixed cut-points. First, binary metrics risk misrepresenting actual delivered care as substantially different practice patterns can result in the same binary result. Second, binary metrics greatly limit the ability to learn from actual practice patterns. Quality improvement projects may be wrongly prioritized based on the national standards and project focus may be misaligned with practice need. EOL care is multifaceted and nuanced; binary metrics are convenient, but may be misleading to practice accountability and limit opportunities for practice improvement. [Table: see text]
Formative research on patient experiences with cancer care.
Authors: Frentzel Elizabeth , Cowans Tamika , Egginton Jason , Evensen Christian , Keller San , Yost Kathleen J. , Sangl Judith , Arora Neeraj K. , Garfinkel Steven 
Published: February 2017

274 Background: The objectives of the formative research were to identify key themes of patient-centered cancer care and determine the best method to collect data to develop the CAHPS Survey for Cancer Care Prototype. This survey seeks to measure aspects of care most important to patients and allow comparisons of those aspects across treatment centers and treatment modalities. Methods: We developed a library of 1,781 items from CAHPS and cancer care surveys. We conducted 14 focus groups with patients (including 2 conducted in Spanish) who had received cancer care in the past 12 months, and 2 focus groups involving family members of cancer patients. We met with 10 experts representing patients and survivors, or who had expertise in quality improvement, oncology, shared decision-making and patient safety to obtain feedback on the development of the survey, potential markets for the instrument, and to assist with overall strategy. Finally, we conducted separate interviews with 5 stakeholder groups representing oncology associations to obtain feedback on focal provider, attribution and sampling. Results: While the focus group results validated findings from the item library, new concepts also emerged, such as the need for having a plan of care. Patients most readily identified with a team of providers, rather than a single provider. The two most important domains to patients were (1) how well the cancer care team communicates with patients and (2) whether the cancer care team keeps patients informed about cancer treatment. Patients were also interested in care coordination, access to information, providers who are up-to-date, and shared decision-making. Stakeholder interviews noted that survey results would be most valuable if presented by treatment modality: medical, radiation, and surgical oncology. Conclusions: These findings suggest that cancer care is best for the patient when providers are knowledgeable and straightforward with medical information, yet can demonstrate empathy and compassion.
Sex and funding trends in phase 3 oncology trials registered with clinicaltrials.gov.
Authors: Moloci Nicholas M. , Yee Sarah , Tomczyk David , Sun Gordon 
Published: February 2017

295 Background: Women have been historically underrepresented as authors of clinical research, which may obscure important scientific interpretations and perspectives. We examined whether primary investigator sex was associated with funding sources of registered phase 3 oncology trials. Methods: We searched ClinicalTrials.gov, identifying completed phase 3 oncology trials registered from 1/1/2005 to 12/31/2010. The first investigator sex and nationality, funding source, and cancer type were collected. Bivariate associations between first investigator and funding source were analyzed with chi-square tests. Temporal trends were analyzed using the Cochran Armitage test. Results: Of 1,365 trials, 882 listed an individual as first investigator and were eligible for analysis; 195 (22.1%) listed a woman as first investigator. From 2005 to 2010 the proportion of women as first investigator across all funding sources did not change significantly (p for trend >.05). The proportion of breast and gynecological cancer trials led by women was significantly higher than the proportion led by men (29.3% of all trials led by women vs. 17.8% of all trials led by men, p<.001). In contrast, the proportions of prostate cancer trials led by women and men were similar (7.7% vs. 6.8%, p>.05). The National Institutes of Health (NIH) funded 95 trials with 32.6% led by women. Private industry funded 305 trials with 19.3% led by women. Of 659 trials funded by other sources such as universities and community-based organizations, 22.6% were led by women. The proportion of women leading industry trials increased from 11.3% to 27.3% (p for trend=.02), while the proportion of women leading trials by the NIH or other sources remained stagnant (p for trend>.05). However, the odds of a woman leading a trial funded by the NIH were 1.84 (95% confidence interval: 1.16-2.92) times greater than the odds for a man (15.9% vs. 9.3%). Conclusions: Women may be underrepresented as lead investigators of oncologic clinical trials, though they do appear to lead a substantial number of breast and gynecologic cancer trials. Primary investigator sex was associated with both funding source and cancer type.
Oncology comanagement agreements (CMA) and quality improvement.
Authors: Haggstrom David , Boustani Malaz , Azar Jose Maroun , Greenspan Andrew , Goe Holly , Cripe Larry Dean 
Published: February 2017

55 Background: At Indiana University Health, an integrated health care delivery system, an Oncology CMA was implemented in 2013 to provide a framework for engagement between administrators and physicians to improve the value of oncology care. Methods: A collaborative process was used to establish shared goals, measures for performance, and set target goals. For efficiency goals, a system redesign approach was taken. Project teams were organized to develop and implement strategies to achieve goals. Experts in implementation science consulted with individual project teams. Financial incentives were distributed across projects. Final performance measures were assessed across the oncology service line. Results: See Table. Conclusions: Overall, the Oncology CMA positively affected the value of care provided by medical oncologists. The level of physician engagement was variable, although clinical and financial benefits accrued to all members of the practice. Based upon the positive contribution of implementation scientists the CMA in 2014 was modified to create greater support for the design, implementation, and assessment of project goals and plans, It is anticipated that future years will include an institutionalized core of implementation scientists and a steering committee to oversee an ongoing discussion of goals and resource allocation. [Table: see text]
How does parental status influence preferences for cancer treatment and palliative care?
Authors: Check Devon , Park Eliza , Reeder-Hayes Katherine Elizabeth , Mayer Deborah , Deal Allison Mary , Yopp Justin , Rosenstein Donald , Hanson Laura 
Published: February 2017

65 Background: When patients with metastatic cancer have dependent children, they may be less likely to acknowledge the terminal nature of their illness and more willing to accept toxic treatments for small improvements in survival, compared to patients without children. Our mixed methods study sought to clarify the role of parental concerns in treatment decision-making. Methods: We recruited 63 patients with metastatic cancer who have children <18 to complete measures of physical and social wellbeing. 47 (75%) also participated in a semi-structured interview, which included questions about whether parental status influences patients’ decisions about anti-cancer treatment and whether patients would consider using palliative care, including hospice. We used univariable logistic regression to examine the relationship between patient and family characteristics and 3 outcomes: 1) influence of parental status on treatment decision-making, 2) interest in palliative care, and 3) interest in hospice. We used participants’ qualitative comments to describe the context for their preferences. Results: Average patient age was 44; average number of children was 2, and average child age was 13. 70% of patients reported that being a parent influences their treatment decisions. 64% cited parental status as motivation for life-extending treatment. 15% prioritized preserving parental functioning. Half of patients said they would consider using palliative care, and 57% said they would consider using hospice. Reasons for disinterest in palliative care and hospice included concerns about being perceived as giving up and children’s exposure to death at home. Parents with older children (OR 0.85, p=0.03), and those with increased social support (OR 0.96, p=0.05) had lower odds of reporting an influence of parental status on treatment decisions. Children’s age (OR 0.85, p=0.02) and low performance status (OR 4.3, p=0.02) were associated with palliative care interest. Conclusions: Parental concerns may influence treatment decision-making for metastatic cancer patients with children. Information about parental concerns may help oncologists to align treatment with patients’ priorities.