bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilizing information and telehealth technology to enhance clinical ethics education outreach.
Authors: Gallagher Colleen M. , Moore Jessica Anne , Campbell Brittany C 
Published: February 2017

149 Background: Integrated Ethics provides continuing education monthly for physicians, nurses, social workers, and others to enhance knowledge and understanding of ethical challenges associated with patient care and research. These are offered live at the main campus. There are four regional centers within a thirty-five mile radius of the main campus. Participants from those locations used to have to come to the main campus to participate. This project was initiated to help alleviate rising financial costs associated with the online recording/redistributing of continuing education credit presentations, travel expenses for regional center employees, removal of employees for 4+ hours from the regional centers daily clinical operations to attend presentations, and payment to outside institutions to obtain required ethics CME and CEU credits. Methods: Steps included internal and external discussions, establishing the need, tracking current process, determining which resources were needed, and then updating the process and evaluating it. Among the primary elements was the inclusion of nursing leaders, physicians and social workers from the centers. Ethics staff went to each center for discussions which had the added value of building relationships. Telehealth and information technology representatives assisted in developing the possible methods for delivery of the education and provided information about the process and costs of each for evaluation. Of note was the fact that the profession of the attendees was different among the main campus and regional centers. At main campus 58% of the attendees are physicians, at the regional center 66% are nurses. Varying requirements for continuing education in the professions had to be accounted for in the selection of method delivery and accreditation processes. Results: This project saves a minimum of $22,634 annually and participation at the Regional Care Centers increased by 20%. An average of 309 productivity hours are no longer lost at the centers. Conclusions: Understanding and utilizing new technology and consistent personalized communication efforts realized both cost savings and increased participation.
Real-world treatment patterns and health care resource utilization (HRU) among patients with chronic lymphocytic leukemia (CLL) by regimen.
Authors: Schenkel Brad , Ellis Lorie , Korrer Stephanie , Byfield Stacey DaCosta 
Published: February 2017

15 Background: Few studies examine HRU of CLL, the most common hematologic malignancy in adults. This study describes HRU by the most common regimens among CLL patients (pts). Methods: A retrospective study using a large, national U.S. claims database from 1/2007-10/2013 was conducted. Adult CLL pts (≥2 claims for CLL) with ≥1 claim for systemic anticancer therapy (SACT) were identified; first SACT claim date was the index date. Pts had to have a CLL diagnosis ≤3 months (m) prior to the index date and be continuously enrolled (CE) in the health plan for 24m pre- and ≥6m post-index date. Pregnant pts and those with SACT in the pre-index period were excluded. A line of therapy (LOT) started with the first SACT; regimens included all agents received in the first 60 days. LOTs ended at the earliest of, start of a new drug, ≥60-day gap in receipt of initial regimen drugs, death or CE end. All-cause HRU was examined by regimen. Results: There were 946 CLL pts identified. Mean age was 68 years, 63% were male, and by insurance type, 41% were Medicare Advantage vs. 59% commercially insured. During the first LOT, 96% and 78% of pts had ≥1 office or hospital outpatient visit with mean per patient per month (PPPM) visits of 4.3 (standard deviation, SD = 2.8) and 2.2 (SD = 2.8), respectively. 31% and 25% had ≥1 ER visit or inpatient stay with mean PPPM visits of 0.2 (SD = 0.4) and 0.1 (SD = 0.3), respectively. Mean PPPM count of inpatient stay days was 1.4 (SD = 8.0). In first LOT, the top 3 regimens accounted for 56% of pts: FCR: fludarabine, cyclophosphamide, rituximab (19%); R: rituximab (19%); BR: bendamustine, rituximab (18%). During the study period, 318 pts (34%) started a second LOT. The top 3 LOT2 regimens accounted for 52% of pts: R (30%); BR (14%); chlorambucil (8%). Conclusions: HRU of CLL pts varied by initial regimen received. Future studies should examine influences of regimen choice and whether regimen choice is associated with differences in outcomes. [Table: see text]
An electronic intervention to improve structured cancer stage data capture.
Authors: Adelson Kerin B. , Framski Kim , Lazette Patricia , Vega Teresita , Lilenbaum Rogerio 
Published: February 2017

151 Background: Cancer Staging is critical for prognosticating, treatment planning, outcomes analysis, registry reporting and clinical trial eligibility determination. Oncology EHRs have structured staging modules but use by physicians is inconsistent. Typically, stage is entered as unstructured free text in clinical notes and cannot be used for reporting. Instead, institutions depend the tumor registry (TR) which typically lag 6 months behind. Our Cancer Committee determined that real-time capture of structured cancer staging was an imperative. Methods: We created an EPIC best practice advisory (BPA) decision support tool that requires physicians to enter cancer stage if the following criteria are met: 1)unstaged cancer on the problem list 2)EPIC staging module exists for that cancer 3)physician is from a specialty with staging expertise. This BPA was implemented 12/18/14. If physicians chose not to stage they had to enter a reason why. Choices were: 1) cancer diagnosed before 2014, at which the BPA was permanently removed 2) staging studies not yet completed, at which the BPA fired at a future encounter 3) Not a staging provider, at which the BPA no longer fires for that individual provider 4) Cannot stage: document reason, at which the BPA was permanently removed. Results: We used TR data to determine the number of patients who were eligible for staging. In 12 months prior to the intervention, 1480/5222, or 28% of patients who were eligible for staging were staged in the structured staging module. After we launched the intervention, between 12/18/14 and 4/30/15, 1654/1831 or 90% of eligible patients were staged electronically. This is an absolute improvement of > 200% Conclusions: Electronic decision support can dramatically improve rates of structured staging. Such data allows automated reports for clinical trial screening, outcomes analysis, quality comparisons, and reporting. We are now building automated reports for: clinical trial eligibility, Commission on Cancer/ QOPI breast, colon and lung measures, rates of palliative care consultation for advanced disease and outcome measures like disease free interval by stage and overall survival.
Actionable biomarkers in a non-small cell lung cancer (NSCLC) clinical pathway (CP).
Authors: Ellis Peter G. ,   Aurora Health Care, Baystate Regional Cancer Program, Broward Health Medical Center, Kahlert Regional Cancer Center, Indiana University Health, Tennessee Oncology, The Center for Cancer & Blood Disorders, UPMC CancerCenter
Published: February 2017

155 Background: Oncologists use Via Pathways (VP) to drive standardization to best evidence-based cancer care. VP include guidance for biomarker testing and associated treatments. Practices collaborated to analyze the first line non squamous carcinoma NSCLC VP. An unexpectedly large percentage of treatment decisions captured by oncologists in the VP portal had unknown ALK translocation or EGFR mutation test results. The VP was modified to require input of whether or not the test was ordered. This analysis examines the impact of this change. Methods: ALK and EGFR testing responses from the VP database were analyzed pre and post implementation of the change. Treatment decisions were reviewed to analyze prescribing patterns. Results: From 1/1/2014 to 1/29/2015, ~40% of EGFR or ALK testing responses were unknown. Post-implementation (1/30/2015 to 5/31/2015), 29.8% were charted as awaiting ALK results and 9.4% did not order the test; 29.5% were charted as awaiting EGFR results and 7.6% did not order the test. For the combined period, appropriate targeted agents were selected for 91.9% (n = 37) and 86.5% (n = 133) of patients who were ALK translocation positive and EGFR sensitizing mutation positive, respectively. Conclusions: Results demonstrate the ability of CP to promote testing of key biomarkers and use of appropriate targeted agents. Frequent evaluation and modification of pathway content is needed to ensure practice patterns are accurately captured. [Table: see text]
Using information technology (IT) to improve communication between the emergency room and cancer clinic.
Authors: Balchin Katelyn Sarah , Falkson Conrad B , Baetz Tara D. 
Published: February 2017

158 Background: A communication gap was identified at the Cancer Centre of Southeastern Ontario which resulted in oncologists at the cancer centre (CC) not consistently being informed when oncology patients (pt) were seen in the emergency room (ER). An automated IT notification system was developed to inform oncologists when their pt were seen in the ER. Methods: Pt who had been seen within 60 days in the CC were considered active. An IT notification system linked active CC visits and ER visits. A list was generated daily of pt that were both CC and in the ER and this was emailed through a secure system to treating oncologists. Following six months of usage an evaluation was performed which identified which pt were being seen in ER (by disease site, treatment regimen and other factors). A survey evaluated oncologist feedback regarding usefulness of this system. Results: From December 2014 to May 2015 notifications were analyzed. A total of 773 pt (12% of total active cancer patients) had an ER visit resulting in 1267 visits; 56% of pt had more than one visit. Thirty-three percent of visits result in admission to the hospital. The highest usage of the ER was palliative care (26% of pt) and hematology (29% of visits). The risk of dying in the three months following an ER visit was 20% as compared to < 2% for all pt seen in the ER during that time period. Sixty-three percent of the 41 oncologists responded to a survey. The majority used this notification system (85%) and found that the report improved patient care (87%). Oncologists typically used this information to check up on pt information on the electronic medical record and if appropriate visited pt that had been admitted to hospital. Conclusions: Cancer pt who have an ER visit are now automatically being reported to the treating oncologists. This process has been able to identify at risk pt for ER visits and this information will be used to develop targeted measures for these high risk populations. The report is very popular with oncologists and is now considered standard practice at our CC.
A novel auditing procedure for an oral chemotherapy process improvement project.
Authors: Bursua Adam , Sica R. Alejandro , Sencion Katherine , Sidani Amer , Haaf Christina , Sullivan Diana , Venepalli Neeta K. 
Published: February 2017

164 Background: A process to standardize ordering, documentation, and administration of inpatient oral chemotherapy was implemented at the University of Illinois Hospital and Health Sciences System. The process requires oncology clinician review and endorsement of inpatient oral chemotherapy drug orders via an oral chemotherapy note within the electronic health record. Pharmacists are instructed to reject oral chemotherapy drug orders that lack this required documentation. A novel auditing procedure was established in order to track adherence to these new requirements and provide real time and adaptable feedback to front-line staff critical to the project’s success. Methods: To support continuous quality improvement (QI) with this project, an auditing tool was developed in REDCap, a secure, web-based data management application. The auditing tool was originally developed as a traditional web-based data collection instrument with the primary purpose of tracking performance. By utilizing more advanced features offered by the REDCap platform, the auditing tool generated automated follow-up surveys to pharmacists involved in non-adherent outlier cases. The survey solicited information on the root cause of non-adherence, and based on the end-user response, provided adaptable continuing education tailored to this root cause. Results: Between June and September 2015, a total of 67 orders for oral chemotherapy were audited. Compliance with process improvement requirements was noted in 58%, 100%, 78%, and 93% of cases in June, July, August, and September, respectively. Outlier surveys were sent to 12 pharmacists in the non-adherent cases; of 11 responses, the most common response reflected an unfamiliarity with the process. Following targeted education, through September 2015, no single pharmacist has been involved in more than one non-adherent case. Conclusions: The novel auditing tool supported the continuous quality improvement process by engaging front-line staff, generating automated and real time surveys for outlier responses, and providing targeted and personalized education aimed at resolving the root cause in non-adherent cases. As such, it can be applied towards any REDCap QI projects.
Creating an online resource providing hospital cancer surgery volumes in California.
Authors: Clarke Christina A , Baker Laurence C , Malin Jennifer , Parker Joseph , Holliday-Hanson Merry , Fong Niya , Teleki Stephanie , Lang Lance , O'Sullivan Maryann 
Published: February 2017

172 Background: Little evidence is available to help patients and providers, payers and policymakers find the highest-quality hospitals for cancer surgery. We initiated a groundbreaking effort in California ( www.calqualitycare.org ) to publicly report hospital cancer surgery volume data online. Methods: With financial support from the nonprofit California HealthCare Foundation, we assembled a multidisciplinary team to oversee the project and ensure sound methodology. We obtained existing hospital discharge summary data from the California Office of Statewide Health Planning and Development (OSHPD). We selected cancer surgeries eligible for display through comprehensive review of the literature addressing the association of hospital volume and mortality. We found eleven cancer sites with sufficient evidence of association including bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach. Experts advised volume calculation and display of results. Leaders of low volume hospitals were interviewed to understand the reasons for low volume. Results: In 2014, about 60% of cancer surgeries in California were performed at hospitals in the top 20% of volume, but many hospitals performed low numbers of complex procedures, with the per hospital median number of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries at 4 or less. Low-volume hospitals included rural and urban hospitals, with small and large bed sizes, and teaching and non-teaching status. At least 670 Californians received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer site; 72% of those patients lived within 50 miles of a top-20% volume hospital. Conclusions: This project demonstrates the potential for public information about hospital volumes to point patients towards high-volume and away from low-volume hospitals. Data regarding 2014 volumes are now available online.
Validation of a real-time patient-reported experience measurement tool for cancer patients in Ontario.
Authors: Moody Lesley , Benn Sarah , Ieraci Luciano , Ingale Saurabh , Singh Simron 
Published: February 2017

174 Background: Cancer Care Ontario (CCO) organizes and ensures quality cancer care for 16 million residents in Ontario. CCO's goal is to create a tool to enable reporting of the patient experience in real time. The study objective was to develop a validated real-time (close to or at point of care) patient reported experience measurement (PREM) tool to drive quality improvement, advance system planning and ensure cost effective resource allocation based on patients’ needs, wants and preferences in ambulatory oncology treatment phase. Methods: Consisting of 28 questions – 18 core questions; 2 open-ended responses; and 8 demographic questions the tool underwent cognitive testing with patient family advisors and was validated using a pilot at 6 cancer centres from April to August, 2015. It was administered using several delivery modes: tablets, patient portals, post cards and paper. The patient journey in visiting centres was conceptualized as containing the steps or domains of interest: arrival, appointment/consultation and overall experience. To validate the patient experience conceptual model, an exploratory factor analysis was performed and compared to CCO’s 8 domain patient experience model. Reliability and validity of the tool was tested using Cronbach’s alpha and multiple variable regression analysis in partnership with Ipsos Reid. Results: 557 responses (496 electronic and 61 paper) formed the basis of the analysis. The tool was shown to be both valid and reliable - an overall adjusted R2 value of 64% from multiple variable regression on overall patient experience; and an overall Cronbach alpha value of 0.83, respectively. Individual Cronbach alpha values ranged from: 0.69 for “appointment/consultation”, 0.55 for “overall experience” and 0.24 for patient “arrival.” Conclusions: Statistical analysis results were used to produce a final validated tool for deployment to systematically capture PREMs through an electronic system in Ontario, Canada in 2016.To our knowledge this is the first of its kind. Collection of real time PREMS will ensure local and system level planning and quality improvement in the cancer system are rooted in what matters most to patients and their families.
Contralateral prophylactic mastectomy decision-making in the population-based iCanCare study of early-stage breast cancer patients.
Authors: Jagsi Reshma , Hawley Sarah T. , Griffith Kent A. , Janz Nancy K. , Kurian Allison W. , Ward Kevin C. , Hamilton Ann S. , Katz Steven J. , Morrow Monica 
Published: February 2017

177 Background: Contralateral prophylactic mastectomy (CPM) use is increasing in women who are not at increased risk of contralateral cancer development and will experience no survival benefit from the more morbid procedure. Little is known about treatment decision-making or provider interactions. Methods: We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer who were treated in 2013-14, identified through the population-based SEER registries of Los Angeles and Georgia about 3 months after surgical treatment, and merged with SEER data (N=2632, RR=70%), to determine receipt of diagnostic tests and factors related to the decision about surgery (including knowledge and perceived physician recommendation). Results: Nearly half of 2,436 respondents with unilateral non-metastatic cancer considered CPM (25% strongly). Only 37% of those who considered CPM knew that it does not improve survival for all women with breast cancer (24% believed it does, 39% didn’t know). Among women receiving CPM, 37% believed it generally improves survival. Ultimately, 1,464 (60%) received BCS and 972 (40%) mastectomy (of whom 438, or 18% overall, received CPM). On multivariable analysis, pts who received CPM were younger, more likely to be white, and more likely to have a family history, private rather than Medicaid insurance, and received MRI. Even among pts without a deleterious genetic mutation or family history in multiple relatives (2,303), 400 (17%) received CPM. CPM was uncommon among pts who reported that their surgeons recommended against it (2.0% [17/832]) but much higher among those who reported no surgeon recommendation regarding CPM (21.3% [229/1,077]), and among those who perceived their surgeons to have recommended it (55.4% [147/265]). Conclusions: Many patients consider CPM, but knowledge is low. Use of CPM is substantial among patients without clinical indications but is low when patients report their surgeon recommended against it. In the context of shared decision-making, surgeon recommendations against CPM might help reduce potential overtreatment.
Patient and oncologist discussions of treatment costs.
Authors: Hamel Lauren M. , Eggly Susan , Penner Louis , Chapman Robert , Klamerus Justin Frank Antoni , Albrecht Terrance Lynn 
Published: February 2017

178 Background: Financial toxicity–the burden of treatment costs and its impact on well-being, treatment decisions, and outcomes—affects many cancer patients, especially racial minorities. Discussing cost during clinic visits may ease financial toxicity, but oncologists are often hesitant to discuss cost. A better understanding of cost discussions is needed to improve care and inform oncologist training interventions. We conducted an observational study of patient-oncologist treatment cost discussions during clinic visits. Methods: Data were video-recorded clinic visits of African American patients (114) and their medical oncologists (19) meeting for the first time to discuss treatment. Cost discussions were any verbal expression of a direct (paying for scans) or indirect (time off work) expense to the patient for treatment. Trained coders observed the videos and coded for presence, duration, initiation, topic, oncologist response, and patient reaction of cost discussions. Results: Cost discussions occurred in 44% (n = 50) of the visits with a range of 1-6 per visit for a total of 93 discussions (M = 35 seconds; SD = 28). Patients initiated (61%) more than oncologists (38%), and patients were more likely to initiate multiple times. Time off work was discussed most (48%), followed by insurance (26%), transportation (12%), paying for treatment (8%), and job loss (4%). Time off work was the most commonly patient initiated topic and insurance was the most commonly oncologist initiated topic. Oncologists typically addressed the issue (72%), and patients often reacted positively (81%) but passively. A few times (9%) the oncologist acknowledged the patient’s initiation but did not address it. Negative patient reactions were rare and only occurred when the oncologist responded to a patient initiation (5%). Younger patients were more likely discuss cost than older patients (p = .02) and retired patients were less likely to discuss cost (p = .05). Conclusions: Findings suggest discussing indirect cost is important to patients, but oncologists infrequently initiate and do not always respond adequately when patients initiate. Further research and interventions are needed to address patient-oncologist cost discussions and the economic impact of cancer treatment.