bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reducing hospital aquired pneumonia (HAP) with Massey Screen.
Authors: Slavin Kerri , Dunbar Robyn , Clements Cheryl , Bonawitz Margaret , McGovern Joanne 
Published: February 2017

232 Background: Hospital Acquired Pneumonia (HAP) is a leading cause of prolonged hospitalization in patients. The oncology population is especially susceptible to critical illness related to an immunocompromised state. The purpose of this study was to implement the Massey Bedside Swallowing Screen upon admission to the oncology telemetry unit to detect any deficits that could potentially lead to HAP, in conjunction with strict oral care for identified high risk patients. Methods: The importance of the Massey Bedside Swallowing Screen upon admission and the knowledge that early detection leads to better patient outcomes was educated to the nursing staff. Every patient admitted to the oncology telemetry unit was screened with the Massey Bedside Swallowing Screen. Patients identified as high-risk were placed on nothing-by-mouth (NPO) precaution. A Speech and Swallow Evaluation was ordered to further evaluate the patient. Acutely ill oncology patients unable to perform their own oral care were placed on a strict oral care regimen performed by the nursing staff. The charge nurse audited compliance with this protocol. Results: The pre-intervention phase of the study evaluated January – April 2015 included 1,605 patient days. The data revealed 4 HAPs acquired on the oncology telemetry unit, demonstrating 2.45 incidence/1000 patient days. Post-intervention [May – August 2015] indicated 2 HAPs acquired on the oncology telemetry unit, signifying 1.35 incidence/1000 patient days. With the implementation of the Massey Bedside Swallowing Screen for each patient upon admission, and strict oral care regimen for high-risk patients, the overall incidence of HAP on the unit decreased by 50%. Conclusions: Oncology patients assessed with the Massey Bedside Swallowing Screen upon admission to the oncology telemetry unit were noted to have improved outcomes and lower rates of HAP. Every oncology patient admitted to an acute care unit should have an admission screen in place to evaluate risk for aspiration. Early detection of patients at high-risk for HAP and implementation of interventions to improve oral care in high-risk patients lead to improved patient outcomes through lower incidence of HAP in the acute care setting.
Reducing pain, agitation and delirium to optimize outcomes in mechanically ventilated critically ill oncology patients.
Authors: Kennedy Michele , Bullick Dana , Barniak Sharon , McGovern Joanne , Patel Trisha , Hoag Jeffrey 
Published: February 2017

233 Background: Greater than 60% of cancer patients experience chronic pain which is heightened in critical illness. Optimal pain assessment is challenging in the critically ill leading to under treatment due to sedation during mechanical ventilation (MV). The Society of Critical Care Medicine (SCCM) favors treating pain with intermittent boluses rather than continuous infusions; however,appropriate analgesic doses and means of titration are elusive leading to over sedation, prolonged ventilation, and delirium. Utilization of protocols promotes better nursing assessment of sedation-delirium scores which reduce the use of sedatives. The purpose of this study was to assess the need for a nurse driven pain-sedation protocol in ventilated oncology patients. Methods: This retrospective study included 51 mechanically ventilated oncology patients admitted between12/2013 and 6/2015. The analgesics, sedatives, dosing and duration of MV were collected. Sedative titration was evaluated relative to analgesics used by nursing staff. Results: Fentanyl was administered in 94% of patients, an average rate of 142mcg/hr (3413mcg/day) significantly higher than rates of 43mcg/hr). Midazolam was administered at an average rate of 1.25mg/hr in 57%, while 54% received propofol (15.5mcg/hr), demonstrating concurrent use of sedatives and analgesics. In 49%, sedatives were increased without prior adjustment of analgesics indicating that pain was unaddressed and undertreated. In the setting of over-sedation nursing neurological assessment was difficult and associated with prolonged duration of MV (9.7 days). Conclusions: Guidelines recommend “analgesia-first sedation” to promote use of analgesic agents over sedatives to treat pain and agitation and reduce undertreating pain. This becomes crucial in the oncology population. This study demonstrates inconsistencies with guidelines and further supports the need for a structured pain-sedation protocol to decrease over-sedation, adequately treat pain and potentially decrease delirium and prolonged MV. Subsequently, a protocol has been developed which will be implemented after education has been provided to the multidisciplinary team.
Burden of bloodstream infections among ambulatory pediatric hematology/oncology patients with a central line.
Authors: Barysauskas Constance , Bundy David G. , Gaur Aditya H. , Hord Jeffrey D. , Miller Marlene R. , Werner Eric J. , Winkle Cindi , Billett Amy 
Published: February 2017

262 Background: Pediatric hematology/oncology (PHO) patients are at high risk of bloodstream infections (BSI). The burden of BSI in PHO patients in the ambulatory setting has not been well documented. Methods: The Children’s Hospital Association leads the Childhood Cancer and Blood Disorders Network, a multicenter United States quality improvement collaborative, working to reduce the incidence of inpatient and ambulatory Central Line-Associated BSI (CLABSI) among PHO patients. Positive blood culture events (+BCE) were adjudicated as CLABSI, single positive blood cultures (SPBC) with potential commensals, or secondary BSI (attributed to source other than the central line) following standardized National Healthcare Safety Network definitions. Our study investigated the prevalence of +BCE among all centers with 90% complete monthly reporting of both +BCE and central line days (CLD) for at least one year (n=25) between January 2012 and September 2014. Ambulatory and inpatient BSI rates and 95% confidence intervals (CI) were calculated as the number of +BCE per 1,000 CLD per month. Results: A total of 1,747 +BCE and 4,883,413 CLD were reported among our target ambulatory population, whereas 1,095 +BCE and 353,259 CLD were reported among our corresponding inpatient population [Table]. While the CLABSI and SPBC rates were significantly lower in the ambulatory setting compared to inpatient (p<0.001), the total number of ambulatory CLABSI and SPBC events was 2.0 and 1.6 times higher than inpatient events, respectively. Conclusions: Our findings from a large multicenter collaborative demonstrate the burden of BSI among ambulatory PHO patients and identify benchmarks for future quality improvement work.Further investigation is necessary to develop effective infection reduction strategies for ambulatory PHO patients with central lines. [Table: see text]
Measuring cancer care quality: An update on development and validation of the CAHPS survey for cancer care prototype.
Authors: Yost Kathleen J. , Evensen Christian , Keller San , Garfinkel Steven 
Published: February 2017

270 Background: At the 2013 ASCO Quality Symposium, we presented the formative development work and results of the 1st field test of the Cancer CAHPS survey. At that time, we noted next steps in the development and validation of the survey. In this poster/presentation, we will provide updates on these activities. Methods: The Spanish translation was completed in 2013. We conducted interviews with 9 cancer patients in 2014 to identify composite labels that resonated with consumers. We collaborated with diverse cancer care providers (health maintenance organizations, medical foundations, small oncology practices, and comprehensive cancer centers) to identify an approach to sampling patients that could be standardized across settings. With the input of stakeholders, we added additional Shared Decision Making (SDM) and Access to Care questions. Data on the revised survey were collected in a 2nd field test from May 2015 – November 2015. We will analyze these data to assess the feasibility of the sampling approach and confirm the psychometric properties of the survey. We embedded several secondary experiments in the 2nd field test including assessing the effect of language (Spanish vs. English) and mode of administration (mail only vs. web-mail mixed mode) on survey responses. Results: The Spanish-language survey is currently being fielded. Consumers identified “user friendly” composite labels, abbreviated here as Communicates well, SDM, Explains treatment, Supports self-management, Access, Delays, and Claims. We developed a comprehensive sampling approach that relies on billing data to identify cancer patient eligible to receive the survey. Preliminary findings indicate that the standardized sampling approach is feasible. The survey was administered to 3,581 patients across 4 cancer centers (i.e. reporting units) in the 2nd field test. Results of the psychometric analyses and embedded experiments will be completed in December 2015 and available for dissemination in January 2016. Conclusions: The cumulative findings from the 1st and 2nd field tests and other development activities conducted to date will be used to support an application for the CAHPS trademark.
Psychosocial oncology quality indicators prioritization exercise.
Authors: Cadotte Tory , Ismail Zahra , Moody Lesley , Rugg Maria 
Published: February 2017

277 Background: One of Cancer Care Ontario’s (CCO) roles is to monitor and report on cancer system performance to support quality improvement. CCO’s Psychosocial Oncology (PSO) program developed a measurement plan with potential indicators to evaluate patient access to and the effectiveness of PSO services across the province. The objective of this study was to conduct a modified Delphi process to build consensus and prioritize PSO indicators based on their relevance to provincial goals, ability to measure regional and provincial performance and result in tangible actions. Methods: Through consultations and literature reviews, 16 measurement concepts were identified as quality indicators for the PSO Program. Members of the PSO Provincial Committee (n = 32) evaluated each indicator based on set criteria: relevance, outcome-focused, directional, and actionable. Two rounds of input was gathered through a structured worksheet with a minimum response rate of 60%. Round one was based on a simple ‘Yes or No’ response to the indicators’ ability to meet the defined criteria. Participants were encouraged to comment on each indicator and suggest new indicators. Indicators not meeting at least half of the evaluation criteria, on average, were removed from the list. Net new indicators suggested by at least 10% of respondents were included in round two. In round two, members rated each indicator on a scale of 1-5, indicating to what degree the indicator met the evaluation criteria. Results: After round one, the original list was narrowed from sixteen to nine indicators. Four new indicators were also added. After round two, three indicators were identified as meeting the evaluation criteria: 1) wait times to specialized PSO services, 2) access to registered dietitian services by the head and neck cancer population, and 3) documented follow-up with patients with anxiety and/or depression. Prioritized indicators were reviewed with the PSO Committee and CCO senior leadership to confirm direction. Conclusions: The prioritization exercise provided consensus across divergent perspectives and identified top priorities. Work is underway to further develop/refine these indicators for provincial reporting.
A new digital classification schema to detect treatment variances and enable value-based payment reforms.
Authors: Pecora Andrew , Schultz Eric V , Choi Kelly , Kea William , Smith Augie , Kim Cindy , Axelrod Matthew , Fletcher Teresa , Love Matthew , Pe Benito Ruth , Daswani Samira , Kaur Sukhi , Tanenbaum Kathyrn , Schaffer James , Hasan Ali , Raj Dilip , Prabhu Kumar Bharath , Suryadevara Kiran , Callahan Ryan , Goldberg Stuart L. 
Published: February 2017

28 Background: Value based payment reforms which improve the outcome to cost ratio (paying for outcomes not for services) require detailed information on both elements. Although the digitalization of medicine via the EHR may facilitate data collection, the imprecise ICD9 and ICD10 schemas hinder analysis (eg: all breast cancers are ICD9 174.9). A more precise classification schema that accounts for biologic variances to allow analysis (and reduction) of treatment variances is needed. Methods: We have developed a digital classification (COTA Nodal Address) based on known clinically relevant prognostic variables. (eg: breast cancer variables include stage, tumor size, hormone status, her2 neu status, etc.). The digital classification also accounts for therapy status (neoadjuvant vs adjuvant, etc.) and line (1st or 2nd treatment, etc.). Results: Using breast cancer as an example, there are > 2975 unique CNA phenotypes that encompass prognostic and treatment status variables. However, in a series of 1204 patients in a community setting only 114 CNAs have been utilized, suggesting biologic disequilibrium. Two phenotypes accounted for the top 25% of cases, 6 for the top 50% and 16 for the top 75%. Early stage, small tumor, hormone receptor positive were most common. The CNA classification uncovered treatment variances among patients with similar phenotypes. In an ongoing episodes of care payment program, young breast cancer patients with early stage, good performance status, hormone positive, her2 neu negative, very small tumors (with similar extended attributes) received varying adjuvant treatment strategies (hormone alone 46% , non-anthracycline 35%, anthracycline chemotherapy 4%, observation 1%). Conclusions: Unlike ICD9/10 systems, a digital classification schema that precisely segregates cancers into unique cohorts based on complete biologic characteristics can rapidly identify behavioral variances at scale that drive differences in outcomes and costs. Using the breast cancer model, we have noted demographic disequilibrium in cancer presentations (potentially a factor of both biology and screening practices) and major variances in treatment strategies (with impact on outcomes/ costs).
Why do patients still go to low-volume hospitals for complex cancer surgery?
Authors: Liu Jason B , Bilimoria Karl Y. , Mallin Katherine , Ko Clifford Y. , Winchester David P 
Published: February 2017

300 Background: While a strong volume-outcome relationship exists for many cancer operations, patients continue to undergo these operations at low-volume centers. Methods: Patients were identified from the National Cancer Data Base (NCDB) from 2010-2014 who underwent resection for bladder, breast, esophagus, stomach, pancreas, lung and rectal malignancies from 1,406 hospitals. Low-volume hospitals were defined as those in the bottom quartile by surgical volume for each operation separately. Regression models were developed to assess patient-level factors associated with undergoing surgery at a low-volume hospital for their malignancy. Results: Of 633,853 patients identified, 49,926 (7.9%) underwent cancer surgery at a low-volume hospital. The low-volume threshold was 1 case/year for bladder, 34 for breast, 1 for esophagus, 1 for stomach, 1 for pancreas, 5 for lung, and 2 for rectal cancers. For all the cancer surgeries examined, patients were more likely to undergo surgery at a low-volume hospital if they lived in a rural area or if they already had to drive a long distance just to reach the low-volume hospital. Patient demographics, socioeconomic factors, insurance type, comorbidities, and stage of disease were not consistently associated with undergoing surgery at a low-volume hospital across all malignancies. Although breast cancer is a common cancer with a less established volume-outcome relationship, the factors associated with undergoing surgery at a low-volume hospital were similar to those of the more complex cancer operations. Conclusions: Patients continue to undergo surgery at low-volume hospitals due to where they live and how far they have to travel. Regionalization policy initiatives will remain challenging in this population. Efforts should therefore continue to emphasize quality improvement locally at each facility caring for patients with cancer.
The influence of a composite hospital volume of upper gastrointestinal cancer resections on outcomes of gastric cancer surgery.
Authors: Busweiler Linde A.D. , Dikken Johan L. , van Berge Henegouwen Mark I. , Ho Vincent K.Y. , Henneman Daniel , Tollenaar Rob A.E.M. , Wouters Michel W.J.M. , van Sandick Johanna W. 
Published: February 2017

305 Background: There is a known volume-outcome association for complex surgial procedures such as oncologic gastric resections. The aim of this study was to describe the process of centralization for gastric cancer surgery in the Netherlands in relation to other types of upper gastrointestinal (GI) cancer resections and to investigate whether the quality of gastric cancer surgery is affected by the overall experience with those related complex surgical procedures. Methods: Data on all patients (n = 4251) who underwent surgical treatment for non metastatic invasive gastric cancer between 2005-2013 were obtained from the Netherlands Cancer Registry. Annual hospital volume categories were based on the overall volume of gastrectomies, esophagectomies and pancreatectomies together (composite hospital volume). Volume-outcome analyses were performed for lymph node yield, 30-day mortality, and overall survival. Results: The percentage of gastric cancer patients who underwent a resection in a hospital with a volume of at least 20 gastrectomies per year increased. At the same time, the percentage of gastric cancer patients who underwent surgery in hospitals with an annual composite hospital volume of at least 20 upper GI cancer resections, such as esophageal and pancreatic cancer resections, increased. A higher composite hospital volume was associated with a higher lymph node yield, a lower 30-day mortality, and an increased overall survival. Conclusions: In the Netherlands, an increasing proportion of gastric cancer resections is performed in hospitals that are high volume centers for esophagectomies and pancreatectomies for cancer. Experience with these complex surgical procedures has a favorable effect on the outcomes of gastric cancer surgery.
Influencing antiemetic prescribing practices and funding changes through evidence-based guidelines.
Authors: Vu Kathy , Wan Michael , Pardhan Aliya , Redwood Erin , Crespo Andrea , Lakhani Nita , Kaizer Leonard 
Published: February 2017

31 Background: In 2013 Cancer Care Ontario released updated antiemetic recommendations supporting the use of aprepitant-based combinations as 1st line therapy for highly emetogenic and 2nd line therapy for moderately emetogenic chemotherapy and discouraging the prolonged use of 5-HT3 antagonists. In 2014 changes were made in the Ontario drug formulary to align public funding to those recommendations. The impact of the changes in guidance and public funding on prescribing practices are now being analyzed. Methods: Using the Ontario Drug Benefit (ODB) database, data was extracted to analyze the prescribing practices of aprepitant, granisetron and ondansetron for chemotherapy-induced emesis between the pre-funding period (November 2013 to September 2014) and post-funding period (October 2014 to July 2015). Results: Prior to funding changes, an average of 197 prescriptions/month of aprepitant were billed to the ODB program totaling $22,422. After funding, an average of 1,165 prescriptions/month of aprepitant were billed totaling $132,145. This represented a 490% increase in utilization. The combined 5-HT3 receptor antagonists prescriptions/month billed during the respective time periods were 5,592 ($405,604) and 5,536 ($402,628). This represented a 1% decrease in utilization. Conclusions: There was a significant increase in aprepitant utilization and total expenditure to the ODB program indicating strong uptake of the triple-drug recommendation for highly emetogenic regimens. However, there was minimal change in prescribing practices related to the 5-HT3 receptor antagonists, indicating a reluctance to decrease utilization. Further work is necessary to discourage the prolonged use of 5-HT3 receptor antagonists.
Chemotherapy costs associated with receipt of the adoption of oncotype DX in early-stage breast cancer within the SEER-Medicare population.
Authors: Dinan Michaela Ann , Mi Xiaojuan , Reed Shelby D. , Lyman Gary H. , Curtis Lesley H 
Published: February 2017

32 Background: The Oncotype DX (ODX) multigene assay has been previously suggested to result in an overall reduction in the use of adjuvant chemotherapy and associated costs for women with early stage, estrogen receptor (ER)-positive breast cancer. However, the association between adoption of ODX and chemotherapy costs has only previously been considered in theoretical models and has not been examined using actual patient outcomes in real world clinical practice. Methods: Retrospective analysis of Surveillance, Epidemiology, and End Results (SEER) -Medicare data of the association between overall and chemotherapy-specific costs associated with adoption of ODX testing in patients diagnosed with invasive, non-metastatic, ER-positive breast cancer between 2005 and 2009. We limited our primary analysis to women ages 66 to75 to include women in which adjuvant chemotherapy would be most likely to be considered. Total Medicare payments were used to calculate direct costs in the year following diagnosis. NCCN guidelines were used to stratify patients on the basis of clinical and pathologic features into low ( < 1.0 cm), intermediate, and high risk (node positive) disease. Results: A total of 21,272 women met study criteria. Average costs in the year following diagnosis were $31,532 in the overall cohort, and was highest for women with NCCN high risk ($45,192) vs. intermediate ($28,642) or low ($23,662) risk disease. Chemotherapy costs followed similar trends ($4,819, $1,157, and $226 respectively). In multivariable analyses, ODX was associated with a relative decrease in chemotherapy costs among high risk women (RR 0.54, 0.37-0.77), but increased costs among low and intermediate risk women (RR1.36, 1.13-1.26 and RR 3.73, 2.13-56.54). Women with high risk disease had significantly lower absolute chemotherapy costs associated with receipt of ODX (-$2,298, -$3,049 to -$1,547; All P < 0.001). Conclusions: Receipt of ODX testing was associated with relative and absolute decreases in chemotherapy costs, but only in women with high NCCN risk disease. Further research is needed to disentangle correlative vs. causative association of ODX testing with patient outcomes and costs.