bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chlorhexidine bathing to reduce CLABSI in hematopoietic stem cell transplant and hematologic malignancy patients.
Authors: Reeber Christina , Bailey Kelly , Nemec Carrie , Salata Robert A. , Gonzalez Kathleen 
Published: February 2017

119 Background: At University Hospitals Seidman Cancer Center (UHSCC), adult patients with hematologic malignancies (HM) and those undergoing hematopoietic stem cell transplant (HSCT) require a central venous catheter nearly 100% of the time. According to the National Health Safety Network (NSHN), for permanent and temporary line days, the pooled mean infection rate in 2009 was 3.5 and 4.1, respectively. Catheter-associated bloodstream infections (CLABSI) lead to increased morbidity, mortality, length of stay, and cost. At UHSCC, the CLABSI rate for patients on the HM service from August 2010 through August 2011 was 8.0. Methods: It has been demonstrated that the use of Chlorhexidine (CHG) wipes has decreased the CLABSI rate in ICU and long term care patients. We were unable to identify literature evidence or medical centers currently using CHG bathing wipes in their cancer patients, specifically HSCT. A quality improvement project on the effectiveness of CHG bathing on the HSCT and HM populations commenced on April 2, 2012, at UHSCC. This study is also monitoring skin integrity to determine if there are adverse effects. Patient satisfaction is also being assessed. Results: Early results demonstrate a reduction in overall CLABSI rate to 4.3%, and no vancomycin resistant enterococcus (VRE) infections were observed since early April. Adverse effects on skin integrity have not been noted. An unanticipated obstacle is related to the “culture of bathing.” Specifically, caregivers and patients often do not understanding the importance of daily bathing as a key clinical intervention despite repeated education. The team continues to investigate this issue. Conclusions: CHG bathing appears to be an effective, well-tolerated, and minimally invasive intervention in preventing CLABSI in severely immunocompromised cancer patients. Unanticipated obstacles to implementing daily bathing have been encountered and are being addressed. During the course of this project, we also began tracking our CLABSI rate for the entire patient population on the HM HSCT nursing unit along with the service-based rate noted above.
Supervised exercise for cancer survivors during and after active therapy.
Authors: O’Rourke Mark Allen , Franco Regina A , Blackhurst Dawn W. , Trilk Jennifer C. , Hudson Matthew F. , Gluck William Larry 
Published: February 2017

121 Background: Supervised exercise for cancer survivors can reduce symptoms and improve physical conditioning. This program evaluation reports the benefits of a nurse-supervised exercise program for cancer survivor participants both during and after active cancer therapy. Methods: The treating oncologist referred participants to the oncology rehabilitation program, called Moving On, either during or at the completion of active therapy. Participants enrolled in a 12-week program of supervised exercise for one hour, three days per week. Baseline and follow up evaluation included a patient reported fatigue score, on a scale from 1 to 10 (with higher scores indicating more fatigue), and the 6-minute walk test (6MWT), in feet. Results: In calendar 2011, 152 participants enrolled in the program and 91 completed all 12 weeks (completers). Participants were 71% female, 86% Caucasian, 14% African American, 68% enrolled on completion of active therapy, and 32% enrolled during active therapy. More than half were older than 60 years. More than half had cancer diagnoses other than breast cancer. A consistent decrease in fatigue and increase in exercise capacity was seen in subgroup analysis by gender, race, age, status on cancer therapy or after completion of therapy, and diagnosis. Conclusions: In this diverse group of cancer survivors, a program of 12 weeks of nurse-supervised exercise was feasible, substantially reduced fatigue, and increased exercise capacity. It is noteworthy that participants, both on active therapy and after, older and younger, and across diagnosis groups, experienced the benefits of the program. [Table: see text]
Reducing time to initiation of colon cancer adjuvant chemotherapy in a large community-based hospital.
Authors: Bochert Karen , Rentschler Brian , Powers Chris , Slezak Frederick , Mahesh Sameer A. 
Published: February 2017

125 Background: Chemotherapy is standard of care after definitive surgery for stage III and certain subsets of stage II colon cancer (CC). A recent meta-analysis showed that for every 4 week delay in administering adjuvant chemotherapy relative survival decreases by 15%. At our institution, 24% of patients undergoing colon cancer surgery in 2010 subsequently received chemotherapy. On average, this process took 41 days from date of discharge to first chemotherapy (range 12-166 days). We sought to decrease this time to an average of 28 days. Methods: Previously, starting adjuvant chemotherapy was a step-wise process starting from the surgeon’s post operative visit to the medical oncologist’s office visit followed by port placement and finally, the commencement of chemotherapy. We instituted a program of concurrent scheduling of appointments by the colorectal cancer navigator (CRCN) upon availability of the pathology report. Primary end-point was time to start of chemotherapy from day of discharge (TTCD). Results: Twenty-three patients were eligible since inception of the program in September 2011. Of these, 5 declined entry and 2 were under the care of non-participating physicians, hence excluded from analysis. TTCD before and after implementation of the program are shown in the table. Two patients required financial assistance for capecitabine (C) that delayed TTCD to > 4 weeks. Results are shown after excluding those patients as well. Conclusions: Utilizing the CRCN to coordinate appointments for patients who required adjuvant chemotherapy significantly decreased the TTCD which might translate into better CC outcomes. [Table: see text]
Improving new patient access for patients with colorectal cancer.
Authors: Denton Kathy , Campbell Jessica 
Published: February 2017

131 Background: Colorectal cancer is a common and lethal disease. The University of Texas MD Anderson Cancer Center has seen an increase in patients who want colorectal cancer treatment. This increase has had a negative result on the referral to appointment cycle time for new patients. Responding to this, Colorectal split from GI in 2010 and separate processes were developed. A performance improvement team was identified in September 2011 with the goal to decrease the referral to appointment cycle time for colorectal patients. Methods: The PI team Aim Statement was to facilitate patient access to the Colorectal Center by decreasing the days of referral to appointment by 10% within the first year. A retrospective study was conducted of the access data for the previous two years. A comprehensive 3-week audit of access center staff and processes was completed. A key component of project success was process standardization and staff education for the new patient communication. A physician designed and presented colorectal practice guidelines and education to the access staff to helped staff identify the correct first appointment type. Scripting was developed to establish clear patient expectations of their responsibilities obtaining medical records; the structure of the first visit; and to provide consistent answers to FAQ to improve access and the patient experience. Access teams were formed and new processes created for receiving and responding to first patient communication. Scheduling templates were revised to accommodate the increased patient volume. Staff work schedules were adjusted to accommodate the workload. There were also many “quick fixes” identified such as implementing separate fax/phone numbers for Colorectal and GI. Results: Within two years, new patient access time decreased from 19.48 days in fiscal year 2011 to 15.76 days in fiscal year 2012 through May 2012, a 19% decrease. The highest access month in fiscal year 2011 was 29 days and the lowest access month in fiscal year 2012 was 12.71 days, while realizing a 15% increase in referrals. Conclusions: The team realized success with the decrease in access time which provided a better quality patient experience. The next step is to further reduce access time by focusing on a different access process for local patients.
The role, use, and nuances of clinical data systems in oncology quality improvement.
Authors: Belnap Thomas W. , Sause William T. , Rowley Braden D. , Jones Cory , Ruckdeschel John C. 
Published: February 2017

135 Background: Data is essential to achieve meaningful quality improvement. A variety of commercial products are currently available for sophisticated data collection. However, data systems alone are not sufficient to improve quality. Additional resources are required in order to leverage electronic clinical data for meaningful improvement. This abstract outlines the necessary requirements and available methods for data-based oncology quality improvement using the experience of Intermountain Healthcare. Methods: The organizational components required for quality improvement are complex. Successful quality improvement begins with project feasibility, data availability and clinical leadership. Clinical processes are reviewed, data accuracy and availability are confirmed and clinical goals are established. Data collection, validation, and analysis are standardized across multiple facilities and providers. Data must be analyzed and presented in a way that clearly illustrates differences in current performance compared to quality goals, should be tracked over time to ensure real and sustainable progress, and must be combined with other improvement strategies to maximize impact. Results: Once quality reports are generated, a physician champion presents them to clinical staff along with education materials, national guidelines and current evidence from peer-reviewed literature. Clinicians are presented with individualized data comparing their personal performance to de-identified performance of their peers, the facility and the system. Providers are given updated data on a regular basis, the data system is monitored for outliers and the need for subsequent interventions, and additional metrics are tracked to ensure process changes don’t negatively impact quality in other areas. Conclusions: Oncology quality improvement requires both clinical and data infrastructure. Electronic clinical data systems are essential for quality improvement, but are not sufficient by themselves. Additional resources are required to capture, extract, validate and analyze clinical data. Appropriate use of these resources transforms existing electronic data systems into a powerful quality improvement tool.
Understanding the drivers of cancer care at the regional, state, and local levels.
Authors: Williams Ken , Donovan Sarah , Fitall Eleanor , McBride Tilithia 
Published: February 2017

142 Background: Regional, state, and local variations in cancer care necessitate a more thorough understanding of the key drivers of quality at these levels. In this study, Avalere sought to understand how local quality and health information technology (HIT) infrastructures may influence the quality of care to which a cancer patient has access. Methods: Avalere conducted an analysis of the primary influencers of quality and value in each state, cataloguing over 500 public and private quality improvement organizations, including payers; employer groups; and hospitals and alternative care delivery models, such as accountable care organizations and patient-centered medical homes, among others. Recognizing the critical role that health information technology (HIT) plays in underpinning quality improvement efforts, Avalere also catalogued the primary HIT organizations in each state. From this, Avalere conducted a sub-analysis of those initiatives with a specific focus on cancer care to determine how the number of cancer-related initiatives relates to the sophistication of a region’s or state’s quality and HIT sophistication. Results: Avalere found that the sophistication of the quality and HIT infrastructures varied widely from state-to-state and region-to-region, with some areas being significantly less developed than others. Similarly, the number of cancer-related quality initiatives also varied widely, with fewer initiatives found in areas with less sophisticated quality and HIT infrastructures. In addition, major urban areas tend to have significantly more sophisticated infrastructures—and an associated higher number of cancer-related initiatives—than non-urban areas, regardless of regional or state quality or HIT trends, more generally. Conclusions: While national quality improvement efforts receive the most media attention and funding, patient care, including cancer care, is delivered at the local level. As such, in order to improve the quality and value of care cancer patients receive, it is imperative to understand and improve local quality and HIT infrastructures and the barriers to quality associated therewith. This is particularly important in locales without major urban access, such as found in large parts of the Midwest and West.
Impact of early engagement of patients with clinical trial information in a system-based multidisciplinary breast cancer clinic on clinical trial enrollment.
Authors: Pan Minggui , Lee Anita T. C. , Seaward Samantha A. , Ilano Aaron , House Karen , Duran Esther , DuLong Mark , Kavanagh Maihgan 
Published: February 2017

149 Background: Cancer clinical trial enrollment is low at approximately 3% in the U.S., and there is an urgent need for improvement. Informing patients clinical trial information early at their initial appointment after the diagnosis of cancer may improve clinical trial enrollment. To this goal, we have developed a system-based multidisciplinary breast cancer clinic (MDBCC) that evaluates all newly diagnosed breast cancer cases and discuss with all patients eligible clinical trials at their initial appointment. Methods: Our MDBCC team consists of a medical and radiation oncologist, breast surgeon, mammographer, pathologist, geneticist, and breast cancer coordinators, who review all newly diagnosed cases in the tumor board (multidisciplinary breast cancer tumor board) prior to patient’s MDBCC appointment. During the MDBCC visit, each individual patient meets separately with a medical oncologist, a radiation oncologist, and a surgeon to discuss their treatment options. Eligible clinical trials are discussed and presented to patients with informed consent. Clinical trial nurses are dedicated for patients to call and meet for further discussion on the eligible trials after the MDBCC visit. Results: The average annual clinical trial enrollment for breast cancer was 9 cases (approximately 3%) between 2000 and 2006 prior to initiating the MDBCC, improved to 53 (approximately 17%) between 2007 and 2011 after the MDBCC was formed. The enrollment into the NSABP and SWOG trials accounts for the large portion of the accrual. Conclusions: Early engagement of patients with clinical trial information in a system-based MDBCC for all newly diagnosed breast cancer patients dramatically improves clinical trial enrollment.
Improving quality of care and reducing costs with angiogenesis-specific imaging tests in metastatic breast cancer.
Authors: Bodnar Carolyn , Paramore L. Clark , Knopf Kevin B. 
Published: February 2017

150 Background: Anti-angiogenesis (AA) drugs (e.g., bevacizumab) are expensive and their clinical benefit in metastatic breast cancer (MBC) has been challenged. Healthcare reform and financial pressures prioritize programs which improve patient quality of care and reduce costs of unnecessary care. Angiogenesis-specific imaging tests (A-IT) under development have potential to offer earlier, accurate determination of response. For A-IT-identified responders, AA treatment would be continued. For patients identified as non-responders, futile AA treatment and associated toxicities can be avoided and alternative therapies initiated. Methods: A decision-tree model was developed to estimate the impact of A-IT from determination of AA therapy eligibility through to disease progression. Key decision nodes were presence/absence of A-IT (assessing change in biomarker expression across 2 PET/CT scans: at AA eligibility, then after one cycle of AA), A-IT sensitivity/specificity (SE/SP) and clinician adherence to test results (tied to belief that results are valid enough to stop AA therapy). Key model inputs (and base case values): 1) median time to progression (TTP) for current MBC patients on AA therapies (9.5 months); 2) median TTP for A-IT identified responders (13 months); 3) costs of bevacizumab, one cycle ($5,200); 4) percentage of AA patients with hemorrhage (4%); 5) costs of hemorrhaging, per event ($14,694); 6) per patient costs for A-IT ($6,000); 7) estimated SE/SP of A-IT – 95%/75%; and 8) clinician adherence to test results (75%). Results: Based on a cohort of 100 MBC patients, use of A-IT results in 29 patients avoiding futile AA therapy with a saving of $460,000, versus a scenario where A-IT was not used. One-way threshold sensitivity analysis shows A-IT is cost-saving if SP >62% or when clinician adherence is ≥63%; results are not sensitive to AA hemorrhage rate. Conclusions: Use of A-IT could improve quality of care by optimizing AA therapy, i.e., by identifying responders who will experience survival benefit and non-responders who can avoid futile therapy and toxicity risks. Significant cost savings may be possible as a result of early determination of response to AA drugs.
Quality improvement research in oncology: A bibliometric analysis.
Authors: Haq Samir Mohamed , Todd Knox H. 
Published: February 2017

159 Background: As part of the Affordable Care Act of 2010, the U.S. government has established a “National Strategy for Quality Improvement in Health Care,” with the goal of implementing evidence-based research into practice. The quantity of oncology research devoted to quality improvement is uncertain. We use the percentage of quality improvement articles in the oncology literature as a proxy metric to gauge the importance given to quality improvement in oncology. Methods: A MEDLINE literature search was performed on July 14, 2012. We approximated the number of articles published in the field of oncology using a PubMed search with the MeSH (Medical Subject Headings) term “neoplasm” or keywords “neoplasm,” “cancer,” or “oncology.” Results were limited to English language and publication dates between July 2010 and June 2012. From this data, the number of articles concerning quality improvement was approximated using the MeSH term “quality improvement” or keywords “quality improvement.” Results: Of approximately 246,000 English language, oncology-related articles published in the last two years, 314 focused on “quality improvement.” The topic of quality improvement comprised only 0.1% of the oncology literature over this period. Conclusions: Using bibliometric analysis, it appears that research on quality improvement in oncology is infrequent. Quality improvement research has been found effective in other fields and requires increased emphasis by the oncology research community. To improve the quality of care in oncology, evidence-based research in the field of quality improvement should increase.
Use of survivorship care plans to re-engineer breast cancer follow-up.
Authors: Makari-Judson Grace , Hubbard Sandra , Wrenn Tamara 
Published: February 2017

162 Background: Use of survivorship care plans (SCPs) was recommended by the IOM in 2005, but benefits are a subject of ongoing debate. ASCO’s Cost of Cancer Care Task Force cited use of unnecessary imaging and tumor markers in breast cancer follow up amongst the “top five” list to improve quality. Communication with breast cancer survivors about guideline based post-treatment follow-up may be improved with SCPs, however few studies have addressed measurable outcomes. We describe use of SCPs to coordinate follow-up care in a multidisciplinary practice. Methods: In 2009, our breast surgeons, medical oncologists, and nurse practitioners agreed upon guidelines for follow up of breast cancer patients, developed a Survivorship Care Program to follow active treatment and implemented use of SCPs. Prior to 2009, follow up was partly determined at physician discretion and partly patient-driven, often with both medical and surgical providers seeing patients within short spans of time. To improve access to two part-time breast surgeons, guidelines were established to shift follow-up to medical oncologists and nurse practitioners. After diagnosis, patients were given comprehensive SCPs, which included recommended follow-up visits and testing. Wait times and numbers of new surgical patients were measured before and after use of SCPs. Results: Implementation of SCPs occurred during 2009; data from time periods two years before and after SCPs is listed below. Wait times were measured from call to first appointment. New patients included both benign and malignant breast disease. Conclusions: SCPs were useful in re-engineering follow-up habits of clinicians, adding value to each visit and gaining acceptance from established patients regarding recommended surveillance. Patients expressed that uncertainty experienced at the end of active treatment is mitigated by remaining in an environment that can be easily transitioned back to other clinical services. SCPs contributed to reduced wait times and increase in volume of new patients seen by breast surgeons. Future studies should assess contribution of SCPs to reducing unnecessary tests and improving compliance with ASCO guidelines. [Table: see text]
Feasibility of screening hospitalized patients for palliative care.
Authors: Glare Paul A. , Plakovic Kathy , Schloms Anna , Egan Barbara , Saltz Leonard 
Published: February 2017

176 Background: The National Comprehensive Cancer Network (NCCN) Palliative Care (PC) Guideline recommends screening all oncology patients for PC, and to call a consult when the referral criteria are met. There are no data on the feasibility or impact of following this recommendation. Methods: Design: Prospective observational study. From 11/1/10 to 1/31/11, floor nurses screened all admissions under the two teams (“Team A” and “Team B”) of the Gastrointestinal Oncology (GIO) service at Memorial Sloan-Kettering Cancer Center. Team A patients were also evaluated by the referral criteria. Endpoints: Patients screened ‘positive’ if they had any of the clinical situations nominated in the Guideline. A PC consult was triggered on Team A patients who met the referral criteria. Team B patients got PC consults based on clinical judgment. Outcomes: screening rates, nursing satisfaction survey, clinical and operational metrics. Results: 90% (228 of 254) admissions were screened, typically taking < 5 minutes. Both teams’ patients were seriously ill (Table 1a), and it is no surprise 75% (170 of 228) screened positive and that 68% (60 of 87) of screen-positive Team A patients met the referral criteria. Screening generated more consults on Team A than Team B (47 vs. 15 p<0.0001), and they were referred earlier (Table 1b). Nurses (response rate 50%) rated screening as quick and simple but not very helpful. Conclusions: Screening for PC was feasible and sustainable, increasing access to specialist services. The value to a comprehensive cancer center of markedly increasing PC consults through implementation of guidelines needs to be evaluated in well-designed trials. [Table: see text]