bluuebunny/crossref_metadata_2025_split huggingface dataset:
Capturing and addressing emotional well-being: Utilization of ASCO’s Quality Oncology Practice Initiative (QOPI) for performance improvement.
Authors: Hegedus Patricia D. , Bearden James D. , Grant Bruce 
Published: February 2017

207 Background: Palmetto Hematology Oncology (PHO) is the medical oncology practice of Spartanburg Regional Healthcare System (SRHS) and has participated in QOPI since 2009 and earned QOPI certification in September 2011. Emotional well-being assessments and documentation of interventions were selected for a performance improvement project based on QOPI measures from Fall 2009. Methods: Several articles were identified supporting the use of the NCCN Distress Thermometer following a comprehensive literature search and approval was obtained for use. The NCCN Distress Thermometer was administered to all new patients through inclusion in “new patient” paperwork packets. Two physician offices within the practice were piloted with the physicians reviewing the patient reported assessments and documenting any required interventions. All completed NCCN Distress Thermometer forms were also reviewed by the medical social work team, and for scores > 3, interventions by phone or face-to-face were completed by them and documented in the patients’ electronic medical records. Results: Due to the success of the pilot efforts the assessment/intervention process for emotional well-being was expanded throughout the PHO practice, the Gibbs Infusion Center, and Radiation Oncology. The QOPI emotional well-being indicator revealed an increase from the Fall 2009 to Spring 2012 of 36.25% to 96.25%. Conversely, our compliance with intervention by the second office visit decreased from 94.44% to 69.44%, respectively. Conclusions: Although PHO’s scores for the emotional well-being assessment have dramatically improved with implementation of the process improvement initiative, opportunity remains for improving emotional well-being intervention documentation. This initiative highlighted the lack of psychiatric/psychological services available to PHO patients. References: NCCN Clinical Practice Guidelines in Oncology: Distress Management, Version 3.2012; Available at: http://www.nccn.org/professionals/physician_gls/pdf/distress.pdf . QOPI The Quality Oncology Practice Initiative; Available at: http://qopi.asco.org/program .
Predictors of quality radiation therapy completion after breast-conserving surgery.
Authors: Powers Benjamin Daniel , Daly Maureen Patricia , Willis Alliric Isaac 
Published: February 2017

210 Background: Quality radiation therapy completion (QRTC) is critical to quality breast conserving treatment (BCT). Our aim was to identify predictors of QRTC after BCT in an urban setting. Methods: Hospital Tumor Registry Data was collected for female BCT patients Stage I and II. Radiation therapy completion (RTC) was defined as 35 days or more of breast radiation. QRTC was defined as RTC of 35-49 days. Statistical analyses were performed with SPSS. Results: 346 patients were analyzed. Demographic data: Ethnicity: Black n=230 (66.5%), White n=63 (18.2%), Hispanic n=53 (15.3%); Age: < 50 years n=74 (21.4%), 50 – 64 years n=152 (43.9%), > 64 years n=120 (34.7%); Insurance: Medicare n=131 (37.9%), Private n=94 (27.2%), Medicaid n=121 (35.0%). Hispanics (60.4%) were more likely to have Medicaid versus blacks (33%) and whites (20.6%), p<0.001. Majority (52%) of patients live within 3 miles of treatment. More blacks (66.5%) live <3.0 miles than whites (7.9%) or Hispanics (41.5%), p<0.001. There was no significant difference in mean days of RTC by ethnicity (black 46.8, white 46.4, and Hispanic 48.1 days; p=0.75) or total RTC % (black 88.2%, white 97.9%, Hispanic 93.3%; p=0.09). However, a substantial difference was seen in QRTC % by ethnicity (black 51.8%, white 79.2%, Hispanic 57.8%; p=0.03) Multivariate logistic regression of failure to achieve QRTC found associations with black race (OR=2.67), Medicare (OR= 3.46), Medicaid (OR=2.19), and age <50 years (OR=4.13). Conclusions: This study demonstrates high overall % RTC; however, it identifies significant disparities in successful QRTC. Those at greatest risk of unsuccessful QRTC were younger, Medicare or Medicaid insured, and black ethnicity. Distance was not a significant factor in this urban population. Further studies should investigate the specific barriers that may contribute to disparities in QRCT among those at risk groups. [Table: see text]
Validation of electronic prostate cancer quality-of-care measures in the Veterans Health Administration (VHA).
Authors: Shelton Jeremy Bradford , Skolarus Ted A. , Malin Jennifer , Antonio Anna Liza M. , He Ren , Saigal Christopher 
Published: February 2017

213 Background: Quality measures based on chart abstraction are the “gold-standard,” but the costs of measurement limit widespread adoption. Electronically specified measures (e-measures) promise to change this; however, the fidelity of electronic abstraction compared to chart abstraction is unknown. We sought to validate e-measure versions of VHA-developed prostate cancer quality of care measures. Methods: Quality measures were chart abstracted on 11,263 men in the VHA with incident prostate cancer in 2008. We identified and linked VHA cancer registry and administrative data for the same cohort. E-measures were specified iteratively and validated by comparing the sensitivity and specificity of measure denominators and numerators, and the overall pass rates to chart abstracted results. Results: 3 of 6 quality measures and 7 of 10 descriptive measures were successfully validated (see Table). Conclusions: The VHA’s electronic medical record environment and information technology infrastructure are sufficiently advanced to support valid e-measurement that is equivalent to that performed by chart abstraction. [Table: see text]
Monitoring acute care utilization (ACU) during adjuvant chemotherapy for early breast cancer (EBC) as a measure of quality.
Authors: Enright Katherine , Grunfeld Eva , Yun Lingsong , Moineddin Rahim , Dent Susan Faye , Eisen Andrea , Trudeau Maureen E. , Kaizer Leonard , Earle Craig , Krzyzanowska Monika K. 
Published: February 2017

220 Background: Serious chemotherapy associated (CA) toxicities resulting in ACU are a concern when administering adjuvant chemotherapy for EBC. Monitoring ACU during adjuvant chemotherapy may serve as a measure of quality of cancer care delivery. We undertook a population based study of ACU in patients undergoing adjuvant chemotherapy for EBC compared with controls. Methods: All EBC patients diagnosed 01/07 – 12/09 in Ontario, Canada were identified from the Ontario Cancer Registry. Patient records were linked deterministically to provincial healthcare databases. All patients received ≥1 cycle of adjuvant chemotherapy. EBC cases (n = 4,718) were matched to non-cancer controls (n = 4,718) on age and geographic location. ACUs (emergency room or hospitalizations) within 30 days of chemotherapy were identified. If the primary reason for visit was a common toxicity of chemotherapy, the visit was considered chemotherapy associated (CA). All cause and CA visits were compared between cases and controls. Logistic regression models were used to identify covariates associated with ACU. Results: ACU was significantly higher in EBC pts compared with controls for both all cause (42.1% vs. 9.1%, p<.001) and CA (30.7% vs. 2.4%, p<.001) visits. Fever was the most common CA toxicity (22.9% vs. 1.2%,p<.001). Taxanes were significantly associated with increased ACU compared with anthracycline only (see Table). Conclusions: Serious chemotherapy associated toxicity resulting in ACU is common among EBC patients receiving chemotherapy. Interventions aimed at mitigating CA toxicity, particularly with the use of taxanes may reduce ACUs and improve quality of care. [Table: see text]
Chemotherapy dose selection in a diverse sample of medically underserved women with breast cancer.
Authors: Griggs Jennifer J. , Sorbero Melony S. , Liu Yihang , Maly Rose C. 
Published: February 2017

221 Background: Black race, lower socioeconomic status, and obesity have been associated with reduced first cycle doses of adjuvant chemotherapy. There are no data on dosing patterns in Hispanics. The purpose of this study was to investigate chemotherapy dose selection among a diverse sample of patients treated for breast cancer through the Breast and Cervical Cancer Prevention Treatment Act (BCCPT) in the state of California from February 2003 to September 2005. Methods: Extensive medical record review of patients who received chemotherapy was performed. We calculated the first cycle dose ratio by dividing the actual doses of chemotherapy delivered by the expected doses. Expected doses were those in standard chemotherapy regimens. Bivariate and multivariate regression analyses were performed to identify clinical and non-clinical factors associated with dose reductions. Results: Among 658 patients with stages I to III breast cancer in the sample, 522 received chemotherapy. After exclusions, the final analytic sample included 403 women (122 non-Hispanic whites, 21 non-Hispanic blacks, 226 Hispanics, 28 Asians, and 6 of other races). Dose ratios < 0.9 were given to 57 patients (14%). In bivariate analyses, race/ethnicity (p=0.004), body mass index (p< 0.001), comorbidity (p< 0.001), and treatment at a non-academic site (p=0.015) were associated with a dose ratio < 0.9. Hispanics and Asians were least likely to have dose reductions. In multivariable analysis, only comorbidity (p=0.03), severe obesity (p=0.003), and being treated at a non-academic center (p=0.03) remained significantly associated with dose reductions. Race/ethnicity was no longer associated with dose selection. Conclusions: The majority of women diagnosed and treated through the BCCTP received high quality chemotherapy. Clinical factors (comorbidity and obesity) as well as site of care were associated with chemotherapy dose selection. The processes and resources in place at academic medical centers may account for the role of treatment site in quality of chemotherapy dose selection. Efforts to standardize dose selection across obesity status and treatment facilities are warranted.
Receipt of guideline-concordant treatment in elderly African American and Caucasian patients with prostate cancer.
Authors: Chen Ronald C. , Carpenter William Ruffin , Hendrix Laura H. , Wang Zhuang Andrew , Nielsen Matthew Edward , Godley Paul Alphonso 
Published: February 2017

222 Background: Clinical management of cancer patients according to published guidelines is an important quality indicator. Prior studies have demonstrated less aggressive treatments of elderly patients with breast and colorectal cancers, raising concern about potential undertreatment of elderly patients overall. The rate of guideline concordant management in elderly prostate cancer patients is unknown, and we examined this using the Surveillance, Epidemiologic and End Results (SEER)-Medicare linked database. Given that prostate cancer is often slow growing, we were especially interested in guideline concordance in patients with "high risk" (aggressive) prostate cancer. Methods: 15,154 Caucasian (CA) and 2,924 African American (AA) men diagnosed in 2004 to 2007 with localized prostate cancer, age 66 to 79, were included. We characterized the proportions of men who received management concordant with the National Comprehensive Cancer Network guidelines within 12 months of diagnosis. Logistic regression was used to examine the odds of receiving guideline-concordant management while accounting for race, comorbidity (NCI combined index), SEER region, and sociodemographic factors. Results: Guideline concordance was more than 80% for both CA and AA patients with low- or intermediate-risk disease. Among high-risk patients, only 63% of CA and 48% AA patients received guideline-concordant management, mostly due to no treatment or hormonal therapy alone, which offer no curative potential. Findings were almost identical in the subgroup of patients with little or no comorbidity, who have more than 10 year life expectancy on average. On multivariable analysis, AA race (OR .62, p<.001) and increasing age were associated with lower likelihood of guideline concordance for high-risk prostate cancer, but comorbidity was not. Conclusions: There is undertreatment of elderly but healthy patients with high-risk prostate cancer, the most aggressive form of this disease. Our results suggest a bias toward less aggressive treatment in elderly patients with less consideration for comorbidities or aggressiveness of cancer. Guideline concordance in elderly patients with aggressive prostate cancer is low.
Impact on mortality of increasing surgical volumes within hospitals after regionalization of thoracic surgery in Ontario, Canada.
Authors: Bendzsak Anna , Baxter Nancy N. , Darling Gail , Austin Peter , Urbach David R. 
Published: February 2017

225 Background: The causal direction of the volume-outcome relationship in surgery has not yet been established. Our objective was to study the effect of absolute hospital volume of anatomic lung resections and volume changes within hospitals on mortality, length of stay (LOS), readmission (RA), and post-discharge visits to the emergency room (ER visits), during a period of regionalization for lung surgery in Ontario, Canada, to test the theory of "practice makes perfect". Methods: For each anatomic lung resection in Ontario from 2004-2010 we determined the volume change within hospital as the difference in hospital operative volume between the year immediately prior to the date of surgery and year prior to that (Dvolume). We used generalized estimating equations and logistic regression, controlling for clustering within hospitals, to examine the effect of Dvolume, patient factors and year on operative mortality, RA and ER visits. Negative binomial regression was used for LOS. The absolute effect of volume, measured as the 12-month hospital volume prior to each procedure, on outcomes was also examined with the same models. Results: Higher hospital volumes were associated with significant improvements in mortality and length of stay, (for increases of 10 cases, mortality OR=0.98 [95%CI: 0.96-1.00] and LOS RR=0.98 [95% CI: 0.97-0.99]), but not for RA or ER visits. However, increases in within-hospital volume did not lead to changes in mortality (OR=1.00, 95% CI: 0.96-1.10), RA (OR=1.00, 95% CI: 0.99-1.00), or ER visits (OR=0.99, 95% CI: 0.98-1.00). Volume increases within hospitals did lead to small improvements in LOS (RR=0.996, 95% CI: 0.993-0.999). Conclusions: Increasing volumes within hospitals did not lead to improvements in mortality in our study, but did result in small improvements in LOS. The decrease in LOS was likely appropriate as it was not associated with changes in RA or ER visits. A volume-outcome relationship between absolute hospital volume and improved mortality was observed, but was not explained by increasing volumes within hospitals; thus practice did not make perfect for mortality.
Physician inter-annotator agreement in the Quality Oncology Practice Initiative (QOPI) manual abstraction task.
Authors: Warner Jeremy , Drews Reed 
Published: February 2017

226 Background: The Quality Oncology Practice Initiative (QOPI) relies upon the accuracy of manual abstraction of clinical data from paper-based and electronic medical records (EMR’s). While there is no “gold standard” to measure manual abstraction accuracy, measurement of inter-annotator agreement (IAA) is a commonly agreed-upon surrogate. We quantified the IAA of QOPI abstractions on a cohort of cancer patients treated at Beth Israel Deaconess Medical Center. Methods: The EMR charts of 49 patients (20 colorectal cancer; 18 breast cancer; 11 non-Hodgkin lymphoma) were abstracted by separate physician abstractors in the Fall 2010 and Fall 2011 QOPI abstraction rounds. The Fall 2011 abstractors were unaware that the charts had been previously abstracted. We analyzed data elements that were common to both rounds, had data entry for both rounds, and did not contain information expected to change after the Fall 2010 round. Cohen’s kappa (κ) was calculated for encoded data; raw levels of agreement and magnitude of discrepancies were calculated for numeric and dated data. IRB approval was obtained and all investigators completed appropriate human subjects research training. Results: 109 data elements with 2,035 paired entries met the above criteria; four narrative elements were not analyzed. Overall IAA for 1,496 coded entries was κ=0.75; median IAA for n=85 individual coded elements was κ=0.84 (interquartile range 0.30-1.00). Overall IAA for 421 dated entries was 73%; median IAA for n=17 individual dated elements was 67% (interquartile range 61-86%). The median discrepancy for the 113 discrepant dated entries was +6 days (range -217 to +391 days). Conclusions: This study establishes a baseline level of accuracy for a complex medical abstraction task with clear relevance for the oncology community. Despite the fact that all information was available in the EMR, there was disagreement for objective elements (e.g. cancer stage) as well as subjective elements (e.g. patient wellbeing). Given that the observed κ is considered only fair IAA, and that the rate of date discrepancy is high, caution is necessary in interpreting the results of QOPI and other manual abstractions of clinical oncology data.
Examining potential cancer care disparities in an equal access system: Quality of colorectal cancer care (CRC) in the Veterans Affairs (VA) health care system.
Authors: Zullig Leah L. , Carpenter William Ruffin , Abbott David H. , Provenzale Dawn T. , Weinberger Morris , Reeve Bryce B. , Jackson George L. 
Published: February 2017

229 Background: Racial disparities in cancer treatment and outcomes are a substantial problem nationally. The Veterans Affairs (VA) health system is nationwide, with goals of being equal access and delivering high-quality care; however, the presence or extent of racial disparities in CRC treatment and outcomes within the VA is poorly understood. We examined the relationship between race and receipt of National Comprehensive Cancer Network guideline-concordant CRC care in the VA. Methods: We identified 2,896 patients diagnosed with incident CRC between October 1, 2003 and March 31, 2006 from 128 VAMCs. We included white and black patients with invasive, non-metastatic disease, known comorbidity status, age, and marital status. Multivariable logistic regression examined the association between race and receipt of guideline-concordant care (CT scan, preoperative CEA, clear surgical margins, referral to medical oncology for stages II to III; receipt of 5FU-based adjuvant chemotherapy for stage III; receipt of surveillance colonoscopy for stages I-III). Explanatory variables included demographic and disease characteristics. Results: In the final sample of 2,022 men, mean age at diagnosis was 68 years; 85% were white, 52%, married, and 38% lived in the South. Stage was evenly distributed. No significant racial differences existed for most guidelines. Compared to blacks, whites were more likely to undergo surveillance colonoscopy 6 to 18 months following surgery (OR=1.32, 95% CI 1.01-1.73, p=0.04) and marginally more likely to be referred to medical oncology (OR=1.46, 95% CI 1.00-2.13, p=0.05). Patients who were 75 years or older at diagnosis (p<0.01) or with cardiovascular-related comorbidities (OR=0.65, 95% CI 0.50-0.89, p=0.01) were less likely to be referred to a medical oncologist than their younger, healthier counterparts. Conclusions: In general, the VA provides high quality, equal access cancer care; however, there may be room for improvement.
Claims/utilization-based intensity of end-of-life (EOL) cancer care in integrated health systems (IHS).
Authors: Loggers Elizabeth , Fishman Paul Arthur , Ramaprasan Arvind , Earle Craig 
Published: February 2017

230 Background: Little is known about the intensity of EOL cancer care for patients within IHS or those under 65 years of age. This study assessed achievement of National Quality Forum (NQF) benchmarks for EOL cancer care among IHS enrollees aged >20 at death. Methods: Using methods described by Earle, we identified IHS enrollees whose cause of death was cancer (not diagnosed at death or via autopsy) per tumor registry data between 2000-2008. Using claims/utilization data we identified individuals who received chemotherapy (chemo) in the last 14 days of life (C, benchmark (B): <10%) or a new chemo regimen in the last 30 days of life (NC, B<2%); had >1 emergency department visit (ER, B<4%):) or hospitalization (H, B<4%) in the last 30 days of life; died in hospital (HD, B: <17%), were not admitted to hospice (NH, B: <45%), or where admitted to hospice in the last 3 days of life (SH, B: <8%). The percentages were then compared to previously established fee-for-service (FFS) Medicare benchmarks. Results: At death, 4,924 IHS cancer patients were >65 years of age, 3,478 were <65. For those >65, benchmarks were achieved for chemo in the last 14 days of life (5%), death in an acute care hospital (16%), and hospice stay <3 days (4%). For those aged 21-64 years of age at death, benchmarks were achieved for chemo in the last 14 days of life (7%) and hospice stay <3 days (4%). Benchmarks were not achieved in either group for new chemo regimens, ER visits, or hospitalizations in the last 30 days of life or hospice admissions. Conclusions: Most NQF benchmarks for EOL cancer care were not achieved, particularly among the young. Future research should update FFS benchmarks based on current utilization and clarify benchmarks for those <65. Final presentation will include results from at least 2 other IHS. [Table: see text]
Chemotherapy use during the last 30 days of life in patients with cancer.
Authors: Rodriguez Maria Alma , DeJesus Yvette , Cheng Lee 
Published: February 2017

231 Background: Treatment options are increasingly available to patients with advanced cancer. Appropriately timed cession of chemotherapy is a quality-of-care measure in the Quality Oncology Practice Initiative of the American Society of Clinical Oncology. To gain insight into whether communication about end-of-life (EOL) issues might need to be improved, we analyzed chemotherapy use during the 30 days at the EOL (EOLCx) among patients at large cancer center. We also analyzed the presence of electronic DNR (eDNR) orders at the time of death in hospital as a surrogate indicator of EOL discussions. Methods: We reviewed the records of cancer patients (age≥18 years) who received their care at The University of Texas MD Anderson Cancer Center and died between December 2010 and May 2012. Logistic regression was used to measure associations of EOLCx and age, gender, ethnicity, comorbidities, cancer type, and cancer progression. Results: A total of 7,399 patients met the inclusion criteria. The median age was 64 years; 46% were female and 18% had hematologic malignancies (HM). 996 patients (14%) received EOLCx, and of these, 554 died in the hospital (7%, 554/7,399). Of those who died in the hospital, 93% had eDNR orders (no difference between solid tumors [ST] and HM). The EOLCx was higher for patients who died in the hospital than for those who died elsewhere (44% vs 7%) and higher for patients with HM than for those with ST (38% vs 8%). EOLCx was more common in patients with ST with metastases, HM without relapse, and HM with relapse than in those with ST without metastases [odds ratios (ORs), 3.3, 13.9, and 32.8, respectively; all p<0.05]. EOLCx was less common in older patients (≥65 years) than younger patients (OR, 0.6; p<0.05) and was more common in patients with comorbidities than in those without (OR, 1.3; p<0.05) and in patients who were not black or Hispanic than in white patients (OR, 1.6; p<0.05). No difference of EOLCx between genders was found. Conclusions: EOLCx was more common in patients with HM with or without relapse than in patients with ST. Most patients had eDNR orders at the time of death in hospital. The results suggest that communication about prognosis and advanced planning about the goals of medical care is becoming critical part in overall oncologic care plan.