bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patients as partners in managing cancer treatment-related toxicity.
Authors: Redwood Erin , Vu Kathy , Wright Meaghan , Fox Colleen , Ahmad Noor , Simanovski Vicky , Kaizer Leonard , Krzyzanowska Monika K. 
Published: February 2017

215 Background: Cancer Care Ontario is the government agency responsible for improving cancer services across Ontario’s 14 regions. To promote advances in best practices related to systemic treatment, Cancer Care Ontario hosts annual Systemic Treatment Safety Symposia, which serve as a platform to discuss quality and safety issues and results of quality improvement (QI) initiatives in alignment with the Systemic Treatment Provincial Plan. For the first time, the 2015 Symposium brought together patients and providers to discuss gaps and opportunities for improvement in relation to toxicity management (TM) during chemotherapy. The main goal of the event was to define improvement priorities. Methods: The Symposium presents a valuable engagement opportunity with regional stakeholders including medical oncologists, nurses, pharmacists, administrators and patient and family advisors. An interactive agenda was designed to elicit direction from these stakeholders. At the event attendees identified and prioritized improvement opportunities using a simulated investment scenario, where marked bills were given to participants to finance the solutions they felt would best address the challenges posed by current TM. The mock money was counted and analyzed based on the role of the ‘investors’ and the prioritized theme. Results: The Symposium had 92 attendees including 17 patients and caregivers. Themes that emerged are presented in the Table below. Endorsement varied depending on stakeholder group. For example, Access was the top improvement priority for patients, whereas Communication was highest for providers. Conclusions: A one day engagement event that brings together patients and providers can be successful in identifying priority areas for quality improvement. Based on the outcomes of the prioritization exercise, improving access to oncology providers for TM 24/7 was identified as a focus area for provincial and regional QI initiatives. [Table: see text]
Clinical pathways: An emerging tool for quality improvement.
Authors: Kleiner Hillary , Pirog Francesca 
Published: February 2017

222 Background: Clinical pathways have emerged as a tool for payers to encourage provider adherence to evidence-based care. Avalere sought to understand how oncology pathways are incorporated into broader organizational quality improvement initiatives and what impact they have on care quality. Methods: Avalere conducted white and grey literature searches to assess pathways used in quality improvement initiatives. The research was augmented by interviews with leading pathways organizations. Results: Research suggests that pathways can play the following roles in quality improvement: Ensure Adherence to Guidelines. Pathways are typically built on guidelines. Guideline adherence thresholds improve care quality by incentivizing appropriate care. While pathway adherence thresholds are typically set at 80%, little research has been conducted on whether adherence thresholds have improved guideline adherence. Ensure Adherence to Quality Measures. Quality metrics can be tied to pathway adherence, which in turn can also incentivize appropriate care. Quality measures tied to pathways can be used as a risk-mitigation and management tool for providers that assume more risk. Improve Patient Outcomes by Reducing Treatment Variability. Some clinical pathways programs have been shown to improve outcomes. Between 2010-2012, after implementing breast, colon and lung cancer pathways, US Oncology and Aetna experienced 1.2 inpatient days for patients vs. 2.1 prior to launch, as well as a 10% ER visits in the pathways group vs. 14% in the control group. Enable Comparative Outcomes Assessment. CPs could allow for benchmarking of outcomes over time. Treatment choices could be tracked through pathways and the outcomes could potentially be matched to those choices. Conclusions: While pathways have been shown to play a role in quality improvement, initial results have been short-term and isolated. To ensure that pathways can be a viable part of organizational quality improvement, additional research must be conducted on the impact of pathways on outcomes. Additionally, given the lack of pathway transparency and consistency there is a need for increased oversight to ensure that pathways are appropriately incentivizing adherence to guidelines and quality measures.
MD and RN ECOG-PS assessments prior to chemotherapy and concordance rates: A quality initiative at a comprehensive cancer center.
Authors: Shinde Arvind Manohar , Dashti Azadeh , Makoff Eve , Ovasapians Navasard , Hendifar Andrew Eugene , Tuli Richard , Figlin Robert A. 
Published: February 2017

228 Background: ECOG-PS is a widely implemented scale in oncology to assess performance status (PS). Higher scores are associated with poorer tolerance to higher-intensity chemotherapy (Ct). While professional societies recommend limiting Ct in patients with solid tumors and poor PS, the practice remains pervasive. To reduce this practice, in 2014 the Cedars-Sinai (CS) cancer quality committee developed a quality initiative (QI) requiring oncologists to indicate ECOG-PS on IV chemotherapy orders, with a structured hard-stop to evaluate patients with ECOG-PS≥3. Previously ECOG-PS was not required. Ct nurses also scored ECOG-PS, though their evaluation was not reported back to oncologists, and did not affect Ct decisions. Earlier studies have suggested a bias for oncologists to rate the ECOG-PS more positively than nurses when evaluating the same patient. Methods: 1084 of the total 12,259 Ct orders activated from 3/1/14-2/28/15 in a CS infusion center were randomly audited for ECOG-PS scoring by MD and RN for quality assurance. Completion and concordance rates for ECOG-PS were determined. Results: 93% and 83% of charts documented MD and RN ECOG-PS, respectively. 827 charts had both MD and RN ECOG-PS scores. Concordance rates, and discordance directionality are described in the Table. Conclusions: This QI achieved high rates of ECOG-PS documentation by oncologists, and low rates of Ct administration to patients with ECOG-PS≥3. MD/RN concordance rates were similar to those described in the literature. Interestingly, and in stark contrast to previous studies, MDs were more likely to score ECOG-PS as poorer compared to RNs in solid tumor discordant cases. [Table: see text]
Documentation of pharmacist-provided patient education for oral chemotherapy.
Authors: Jennifer Anderson , Venepalli Neeta K. , Fleming Patrick Joseph , Haaf Christina , Bursua Adam , Park Little Irene , Cuellar Sandra 
Published: February 2017

237 Background: Pharmacist-provided patient education for oral chemotherapy is poorly documented in patient electronic medical records (EMR) at UIC Oncology Pharmacy. At baseline, 41% of patients who started new therapy with selected oral chemotherapies had a patient education note documented by a pharmacist in their EMR. Our aim is to provide and document patient education for at least 90% of patients who start new oral chemotherapy and fill their prescriptions at UIC Oncology Pharmacy over three months. The importance of patient counseling and documentation is recognized by the Quality Oncology Practice Initiative (QOPI) group. Approximately 25% of patients undergoing chemotherapy are on oral chemotherapy. (Deutsch S, Koerner P, Miller RT, Craft Z, Fancher K. Utilization patterns for oral oncology medications in a specialty pharmacy cycle management program. J Oncol Pharm Pract. 2014;0:1-8.) Methods: A multi-disciplinary team performed an affinity sort and created a process map to identify areas of intervention. The first intervention was labelling prescription bags to identify them as oral chemotherapy prescriptions that require counseling by a pharmacist. Data was collected after two weeks. Results: At the completion of the first PDSA cycle, 40% of patients who started new oral chemotherapy had a documented patient education note written by a pharmacist in their EMR. Documentation of education was performed on the day of pick-up in 89% of cases. Table 1 shows the percentage of notes that included the elements recognized by QOPI standards: documentation of start date, adherence, and adverse effects. Conclusions: Documentation of patient education for oral chemotherapy should be a well-integrated component of ambulatory pharmacy practice. A second PDSA cycle is planned to increase rates of documentation by utilizing the pharmacy resident to perform patient counseling and documentation. Future interventions will be aimed at improving the quality of the data included in the documented notes. [Table: see text]
National Comprehensive Cancer Network petitions: Submissions and outcomes.
Authors: Bobolts Laura , Huff Dinah Faith , Hrushesky William J. , Bennett Charles Lee , Knopf Kevin , Baum Michael 
Published: February 2017

248 Background: The National Comprehensive Cancer Network (NCCN) invites petitions to its scientific panels. Most ( > 95%) are from the pharmaceutical industry lobbying to include their products in the NCCN Guidelines. Rarely, physicians request scientific scrutiny of the guidelines. We report the experience of Oncology Analytics (OA) with petition submissions and the possible impact on guidelines. Methods: From 2011-2015, OA made 7 petitions to NCCN. The content of each was tracked into subsequent NCCN Guidelines to ascertain whether any changes resulted. Results: 1) The Survivorship Panel was petitioned to add liposomal doxorubicin to the list of cardiotoxic anthracyclines: No changes were made. 2-3) The NSCLC Panel was asked in 2014 to remove the category 2A listing for trastuzumab and afatinib as HER-2 targeted drugs, and cabozantinib as a RET rearrangement target based on absence of phase I-III full text scientific literature. This was done, however, cabozantinib was reverted to 2A status late 2015 based on abstract-only data. 4) Per FDA approval, the NSCLC Panel was asked to recommend bevacizumab only in combination with carboplatin/paclitaxel for 1st line non-squamous NSCLC based on a survival advantage in ECOG 4599: No changes were made. 5) Given the FDA-approval, the Ovarian Cancer Panel was requested to add doxorubicin: This was done. 6) A 2012 Supportive Care Panel petition pointed out the absence of data supporting palonosetron as the preferred 5-HT3 antagonist with aprepitant for moderate or high emetic risk chemotherapy: No change was made upon request; however, preferred status was removed in 2015 from high emetic risk. 7) Based on a preponderance of evidence, a Supportive Care Panel petition requested re-categorization of the febrile neutropenia risk for carboplatin/paclitaxel from intermediate to low except in patients of Japanese ancestry and/or carboplatin AUC > 6: This was done. Conclusions: Majority of NCCN physician petitions came from OA, yet constituted less than 5% of all petitions submitted. NCCN does not provide direct petitioner feedback, so we cannot say for certain that our petitions led to changes in subsequent guidelines. Not all requests resulted in NCCN changes, despite level one supportive data or accentuating an absence of data.
A patient-centered, symptom-focused qualified clinical data registry (QCDR) as a framework to guide quality improvement.
Authors: Struth Deborah L. , Mallory Gail , Galioto Michele 
Published: February 2017

253 Background: Clinically meaningful quality measures have been identified as a catalyst for healthcare improvement and better patient outcomes. Amidst rapidly changing quality reporting and re-imbursement schema, eligible providers struggle to choose a portfolio of measures across multiple registries that will demonstrate the value of their practice to consumers and payers. It is critical that a roadmap to quality improvement be evident to registry users. Utilizing the Model for Improvement developed by the Associates in Process Improvement and adapted to health care by the Institute for Healthcare Improvement, a framework to guide performance improvement was developed and incorporated into an oncology specific QCDR for PQRS reporting. Methods: Fourteen patient-centered quality measures with a focus on cancer related symptom assessment and intervention were piloted and tested in 40 practices and incorporated into the Oncology Nursing Society (ONS)/CE City QCDR. Six measures focus on the active treatment phase of cancer care and eight on breast cancer survivorship. The registry platform was designed with capabilities for tracking of data over time, goal setting, benchmarking, and providing suggested performance improvement (PI) activities. A technical expert panel (TEP) was convened to develop a model to guide PI activities to address QCDR identified practice gaps. Results: A quality improvement framework was developed to help QCDR subscribers answer the question “How Do I Improve” and was incorporated into the ONS/CE City QCDR platform. This framework provides the subscriber with the education and training necessary to improve care through use of quality improvement tools and implementation strategies aimed at practice change. Conclusions: It is essential that measures be incorporated into an infrastructure that provides opportunities for the assessment and improvement of care quality provided by practices. The QCDR can act as a means to drive performance improvement along with supporting quality measurement for PQRS and Meaningful Use reporting. The “How Do I Improve” Framework developed as part of the ONS/CE City QCDR platform provides a model to accomplish this goal.
Patient perception of nighttime noise in the hospital setting.
Authors: Alessandroni Stephanie , Peterson Lynette 
Published: February 2017

258 Background: The national standard survey, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), measures the patient’s perspective on hospital care. One area that continually evokes sub-optimal results is the ‘quiet at night’ measurement. Our investigation explored the patient’s perception of nighttime “noise” in the hospital setting. Methods: Patients in our medical surgical/telemetry floors subjectively evaluated the noise level at night. An ethnographic interview method was utilized that was approved and standardized to prevent bias. Results were stratified and coded. Results: A total of 224 patients completed the process prior to any intervention to provide our hospital with a baseline understanding of the current state. We then utilized two evidenced-based approaches which have been shown to decrease a patient’s perception of noise: a sleep pack consisting of ear plugs, headphones, and a sleep mask, and one-on-one education on how to use the relaxation channel. Of the additional 101 patients who received this education, twenty-seven of these participants completed a second interview the following day, which allowed for comparison data to be compiled. By speaking with the patients, our investigation not only yielded information regarding the perception of noise level in their room, but additionally identified factors that were the cause of the noise. Although, our two interventions did not produce a positive change in noise level, it did provide valuable feedback and insight for quality initiatives. Conclusions: Noise level is a quality issue which needs to be continually addressed. Our interdisciplinary team, along with nursing leadership, intends to move forward with developing a plan to promote an optimal healing environment.
Current landscape of acute myeloid leukemia quality measures in the United States.
Authors: Flanders Scott C , Bui Cat N. , Song Kyung Min , Fitall Eleanor , Mitchell Kristi , Braun Stephanie Greenstein , Bahceci Erkut , Pandya Bhavik , Jagun Dayo 
Published: February 2017

261 Background: Acute myeloid leukemia (AML) is a rare, but deadly hematological, disease with 20,830 new cases estimated in 2015 in the United States (US). As new treatments emerge, quality measures (QMs) will become important to assess the value of care. Our aim was to evaluate the current US AML QM landscape. Methods: We reviewed literature and online resources (eg, National Quality Measures Clearinghouse, Centers for Medicare & Medicaid Services, etc.) published within the last 5 years to identify AML-specific and AML-related QMs. All QMs were categorized using a “continuum of care” framework according to the 5 stages of AML: 1) symptom assessment, 2) diagnosis/risk stratification, 3) initial treatment, 4) monitoring/additional treatment, and 5) advanced/late stage care. Quality measures were categorized by the measure type (eg, process or outcome measure) and use by the Centers for Medicare & Medicaid Services (CMS). Results: In total, 30 QMs were identified: 1 leukemia-specific QM and 29 general oncology QMs. The leukemia-specific QM is a clinician-level process measure that evaluates the percentage of patients aged ≥ 18 years with a diagnosis of myelodysplastic syndrome or acute leukemia who had baseline bone marrow cytogenetic testing performed. Among the 29 general QMs: 8 are specific to stem cell transplantation, 13 are specific to chemotherapy, and 8 are general to oncology. Across the AML continuum of care: 2 QMs focus on symptom assessment, 1 supports diagnosis/risk stratification, 11 are for initial treatment, 9 for monitoring/additional treatment, and 7 for late-stage care. Twenty-seven QMs are based on process of care: 1 addresses resource utilization and 2 are outcomes based. The single leukemia-specific QM is used in CMS quality improvement programs, along with 3 other oncology-related QMs. Conclusions: While only one identified QM was specific to leukemia, other general oncology QMs may also apply. Unfortunately, QMs addressing AML-related morbidity and mortality are still lacking. Research into patient-centered communication, shared decision-making, patient-reported outcomes and resource use by AML patients may inform development of new QMs. Sponsorship: This research was funded by Astellas Pharma, Inc.
Validation and quality assessment of the Kilimanjaro Cancer Registry.
Authors: Zullig Leah L. , Muiruri Charles , Nyindo Pili , Namwai Theresia , Karia Francis , Oresto Michael , Silayo Elvis , Msomba Angelah , Bartlett John , Zafar Yousuf 
Published: February 2017

266 Background: The global cancer burden has increasingly shifted to low and middle-income countries and is particularly pronounced in Africa. However, there remains a lack of comprehensive information about cancer incidence due to limited development of cancer registries. In Moshi, Tanzania, a regional cancer registry exists at Kilimanjaro Christian Medical Center (KCR). The quality of the registry data is unknown. Our objective was to evaluate the completeness and quality of the KCR. Methods: In October 2015 we conducted a retrospective review, validating internal consistency of registry records compared with paper-based medical and pathology records. We randomly sampled approximately 3% of over 3000 registry cases (n = 100), focused on cases abstracted from 2014-15. Four independent reviewers not associated with the KCR manually collected and compared key data elements (e.g., cancer site, morphology, diagnosis date). Data were collected using Microsoft Excel. Data management and analysis were conducted in Stata. Results: The KCR contains information on over 3000 patients from 32 tribal groups and 8 geographic areas in the Kilimanjaro region. All of the 100 reviewed cases had complete cancer site and morphology in the registry. Six had a recorded stage. For the majority of cases (n = 92) the basis of diagnosis was pathology. Pathology records were found in the medical record for 41% of cases; for the remainder, pathology records were stored separately in the pathology department. Of sampled cases, the KCR and medical records were 98% and 94% concordant for primary cancer site and morphology, respectively. For 28% of cases, recorded diagnosis dates were within 14 days of what was found in the medical record, and for 32% of cases they were within 30 days. Conclusions: Although training is needed to standardize diagnosis date definitions, this study suggests that KCR data is high quality. Research is needed to determine effectiveness at ascertaining all patients in its catchment area. The registry may have utility for resource planning and research purposes.
Comparative effectiveness research in renal cell carcinoma: Lenvatinib with everolimus as a potential new treatment option.
Authors: Tremblay Gabriel , Pelletier Corey , Majethia Unnati , Forsythe Anna 
Published: February 2017

27 Background: Renal cell carcinoma (RCC) is the most common type of kidney cancer and represents about 90% of all kidney cancers. As comprehensive comparison of the efficacy associated with mRCC treatments is not available, the goal of this research was to provide a comparative effectiveness analysis including overall survival (OS) and progression free survival (PFS) for first and second line treatments. Methods: Systematic literature review yielded the following randomized active-controlled studies: lenvatinib + everolimus (LEN+EVE) versus everolimus (EVE), axinitib (AXI) versus sorafenib (SOR), cabozantinib (CAB) versus EVE, nivolumab (NIV) versus EVE, and pazopanib (PAZ) versus sunitinib (SUN). In addition, placebo-controlled studies were identified for EVE, PAZ, and SOR. An indirect treatment comparison (ITC) was performed on OS and PFS hazard ratios (HR). Results: Scenario A presents the HR and confidence intervals (95% CI) generated with ITC of all treatments against EVE. In scenario B, the HR of LEN + EVE are compared to all treatment options. Only LEN + EVE and CAB demonstrated significance against EVE for both OS and PFS. LEN + EVE proved to be significant against EVE, PAZ, SOR, SUN, AXI and NIV for PFS and against EVE, SOR and AXI for OS. The use of crossover trials in the network for the treatment compared to placebo remains a potential bias in the results. Conclusions: Even if limitations exist regarding the use of ITC, the option of LEN+EVE demonstrated a strong comparative effectiveness profile for both OS and PFS. [Table: see text]