bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding patterns of genetic risk evaluation (GRE) referral and uptake in patients (pts) with epithelial ovarian cancer (EOC).
Authors: Cao Yu , Morgan Robert , Leong Lucille A. 
Published: February 2017

254 Background: EOC is the most common cause of gynecologic cancer death and fifth leading cause in women. ~20% cases are due to identifiable genetic risk (BRCA1/2 in 15%, Lynch syndrome 2%, other germline mutations 6%). Since 2013, National Comprehensive Cancer Network (NCCN) guidelines recommend all women with EOC be referred for GRE, to optimize risk stratification, genetic testing decisions, clinical management, with goal to reduce mortality. Yet physicians under-refer and pts under-utilize genetic services. Identifying clinically meaningful quality metrics and associated adherence is critical to improving cancer care. We aimed to characterize patterns of GRE referral and uptake in pts with EOC. Methods: Completed GRE was tracked in pts with EOC 2009-2015, using City of Hope (COH) cancer registry and genetics appointments system. Targeted chart review was done for pts identified as without GRE completion in 2014 (18 cases), 2015 (2 cases). Results: 91/191 (48%) analytic pts with EOC from 2009-15 registry data were identified with completed GRE. Targeted chart review of non-adherent cases: 2015: 1/2 pts did not complete GRE (at COH primarily for surgery). 2014: 7/18 pts documented with completed GRE; Pareto chart was constructed for 11 unaccounted non-adherent pts: see Table. Conclusions: 2014-15 GRE completion rate (68%) suggests a higher GRE referral rate, above that reported in literature (<35%). In 2014, 75% pts seen by medical oncology had documented reasons for not completing GRE; 2/11 pts who did not complete GRE lacked a documented reason (see chart). Inability to track paper referrals (used prior to 2014) limited analysis. Promoting multidisciplinary educational interventions for specific audiences, collaboration between community and COH referring physicians, studying physician perceptions of GRE risks/benefits/barriers, EHR enhancements (e.g. creating a GRE check-off item, or documentation aids), and pt-centered assessment of GRE awareness and utilization may improve adherence with NCCN guidelines to 100% (CA33572). [Table: see text]
Analysis of the results of implementation of a pregnancy screening policy at a comprehensive cancer center.
Authors: Trowbridge Gloria , Cleveland David , DeJesus Alma Yvette , Cheng Lee , Wagar Elizabeth Ann , Levenback Charles F. , Rodriguez Maria Alma 
Published: February 2017

256 Background: Institutional implementation of a standard pregnancy screening policy for women will enhance the safe and timely delivery of treatment throughout the care continuum. In 2012, we developed and implemented an initial policy on pregnancy screening test (PST). The policy indicated that all providers should fully discuss with their female patients of child bearing potential regarding the potential risks of cancer treatment on fertility and the adverse effects on the fetus. The providers should also discuss the contraceptive options with female patients and their partners prior to diagnostic studies and/or treatment. In 2015, we revised the initial policy to further clarify timeframe for PST and clinical indicators and also developed an algorithm to support this best practice. We assessed practice changes as a result of the policy changes regarding PST at our institution. Methods: A retrospective data review was conducted to assess the number of PST over a 5 year period at The University of Texas MD Anderson Cancer Center. The timeframe includes both baseline and post-implementation policy and reflects annual changes from fiscal year (FY) 2010 to 2015. The pregnancy test was defined as measuring human chorionic gonadotropin (hCG) level in a urine sample. Results: We observed a significant increase in PSTs over time among female patients between ages 10 to 55 years. Over 5 years, there were 23,793 urine pregnancy tests performed. The number of urine pregnancy tests performed per FY were as shown on table below (trend test, p< 0.01). The percentage of PST performed among age groups (years): 1.8% of 10 to 15, 11.6% of 16 to 25, 22.3% of 26 to 35, 34.7% of 36 to 45, and 29.5% of 46-55 years old. Conclusions: Wedemonstrated that developing a standard institutional policy on pregnancy screening tests with further enhancements contributed to a significant increase in the number of PSTs performed over 5 years at our comprehensive cancer center. The majority of PSTs were conducted among female patient between the ages of 26 and 55. [Table: see text]
Measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey items between non-Hispanic whites and Asians.
Authors: Hays Ron D. , Chawla Neetu , Kent Erin E. , Arora Neeraj K. 
Published: February 2017

259 Background: Asians report worse experiences with care than Whites. This could be due to true differences in care received, expectations about care, or survey response styles. To examine measurement equivalence of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey items between Whites and Asians. Methods: We conducted multiple group confirmatory factor analyses to evaluate measurement equivalence of CAHPS Medicare survey data between White and Asian Medicare beneficiaries for three CAHPS reporting composites (communication with personal doctor, access to care, plan customer service) and global ratings of care using pooled CAHPS data from 2007-2011. Responses were obtained from non-Hispanic whites (n = 1,326,410) and Asians (n = 40,672). The median age for whites was 70, with 24% 80 or older, and 70 for Asians, with 23% 80 or older. Fifty-eight percent of the whites and 56% of the Asians were female. Results: A model without group-specific estimates fit the data as well as a model that included 12 group-specific estimates suggested by Lagrange multiplier tests (Comparative Fit Index = 0.922, Root Mean Square Error of Approximation = 0.064). Three of the 12 group-specific estimates consisted of 7 factor loadings, 3 measured variable errors, and 2 item intercepts. Six of the factor loadings were larger for Asians than for whites. Conclusions: This study provides general support for measurement equivalence in response to the CAHPS Medicare survey composites (communication, access, customer service) and global ratings between White and Asian respondents, supporting comparison of care experiences for the two groups.
Benchmarks of quality breast care over 10 years.
Authors: Kaufman Cary Steven , Tucker F. Lee , Rabinowitz Barbara , Heckel Teresa , Gass Jennifer S. 
Published: February 2017

272 Background: In 2005, the National Quality Measures for Breast Centers (NQMBC) was initiated as a web-based program to capture breast center performance using process of care measurements. The program participant enters data verified by the breast center director or administrator which was randomly audited. As a center submits data, their results are immediately compared with other similar centers as well as with all submitting centers. Methods: Of the 31 measures, we focus on six pertinent measures of quality breast care; time from diagnostic mammogram to needle biopsy, time from needle biopsy to initial breast cancer surgery, breast conservation rate, use of radiation therapy for breast conserving patients, use of endocrine therapy, and use of chemotherapy. Data was submitted in aggregate form, with each center submitting their average performance for any measure every 6-12 months from 2005 to 2014. Each submission included the number of patients used to calculate their submission. For this report, we have defined the “benchmark” as the average performance of all centers submitting data for a particular time period. Results: At the end of 10 years, the time from diagnostic mammogram to needle biopsy decreased by 2 days (207,425 patients reviewed), while the time from needle biopsy to initial cancer surgery increased by 5 days (86,084 patients). Breast conserving surgery markedly decreased 2.4% per year from 2005 to 2010, yet increased 2% per year from 2010 to 2014 (29,455 patients). For use of adjuvant therapies, we saw gradual increase in use. At 10 years, use of radiation therapy was at 92.5%, had increased at 0.7% per year, 6.5% overall increase (13,202 patients); use of endocrine therapy was 89%, had increased at 1.2% per year, 12% overall increase (12,684 patients); and use of chemotherapy was 97%, had increased at 0.5% per year, 10% overall increase (2,467 patients). Conclusions: Benchmarks of quality breast care are necessary as guideposts for providers. While the use of adjuvant therapies have increased over 10 years as expected, the fluctuations of use of breast conserving surgery as well as changes in time spent prior to surgery were unexpected. Benchmarks may change over time in unpredictable ways which supports ongoing monitoring the level of breast quality care.
Quality assurance metrics in clinical trial conduct.
Authors: Li Jennifer , Sellmann Susanna , Philip Lindsay , Guglielmi Cristina , Degendorfer Pamela , Oza Amit M. 
Published: February 2017

274 Background: Quality assurance (QA) in clinical trials is a safeguard against non-compliance, which impacts patient safety and data integrity. On an institutional level, compiling quality findings provides insight to gaps within existing processes, protocol compliance, and educational content. A QA metrics methodology has been implemented, which is streamlined with the ICH-GCP, and institutional Standard Operating Procedures (SOPs) and policies. Methods: Individual findings are assigned an alphanumerical code, based on severity and category, and a reference for each Quality Assurance Review (QAR). Annual data is tracked for all QAR findings. Different data sets are created to allow for analysis of quality gaps and quality changes over time. Results are used in the creation or revision of educational content, SOPs, and to drive process improvement. Results: To date, a total of 1608 QAR observations between 2014 and mid-2015 have been coded and tracked across 22 studies. Areas of quality gaps, such as most-cited categories (e.g. 27% in Source Documentation and 13% in Regulatory) and references (e.g. 30% on SOPs and 14% on guidelines), are communicated to the Quality and Education team regularly and incorporated into training content. This has also prompted the development of new SOPs, processes, and research tools, after which QA metrics continues to be used to monitor program wide quality improvement. For example, following the implementation of Electronic Source Documentation, the proportion of findings on delays in Adverse Event sign off has seen a decline. For individual QARs, a personalized trends summary is provided to the study team with an overview of the quality of the study conduct. The report displays the distribution of findings across different categories and severity levels. Lastly, quality metrics has increased the efficiency of tracking and reporting program wide QA activity. Conclusions: The regular analysis of quality metrics has proven to be a pivotal step in the Quality Management Cycle. It presents a quick snap shot of the quality of individual research studies under review. When implemented on an institutional scale, it offers valuable feedback on the current SOPs, processes, and training content.
Compliance with National Comprehensive Cancer Network guidelines for antiemesis in cisplatin regimens.
Authors: Wolf Terri P. , Little Dana Ann 
Published: February 2017

280 Background: The members of a network of community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines. To determine guideline compliance, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting.The community cancer centers affiliated with an academic medical center report following National Comprehensive Cancer Network (NCCN) guidelines for treatment plans. To determine guideline compliance rates, cisplatin regimens were audited. Cisplatin was selected because of its wide use, high emetic potential, and the impact on QOL for patients with unmanaged nausea and vomiting. Methods: Prior to a chart audit, medical oncologists were surveyed on their knowledge of NCCN antiemesis guidelines, frequency of prescribing based on guidelines, and reasons for not using guidelines. Auditors identified patient charts through billing records and reviewed cycle 1 day 1 orders of cisplatin regimens. Secondary data was collected on hydration orders and home medications for antiemesis. Results: Guideline adherence varied from 0% to 76% with overall adherence at 28%. Dexamethasone doses ranged from 2-20 mg (guideline 12 mg) as did serotonin antagonists (5HT3) ordered at higher IV doses of 24-32 mg (guideline 8-16 mg). Conclusions: Although cancer centers report following the guidelines, this study did not find consistent adherence. The cancer center with the highest adherence rate works closely with a pharmacist and has built order sets with the guidelines. One cancer center had wide variances among practitioners. The variances increase the potential for error. The cancer center with lowest adherence rate used 10 mg doses of dexamethasone because the drug is delivered in 10 mg vials. This study identified multiple systems issues impacting guideline compliance. Managing nausea and vomiting is important for patient QOL and to manage costs by decreasing hospitalizations, treatment delays, and nutritional deficits. Understanding prescribing habits relative to guidelines provides an opportunity to change practice and reduce variability.
Patient surveys for cancer populations: Initial experiences with Cancer CAHPS.
Authors: Tirodkar Manasi , Friedberg Mark W , Fuld Nasso Shelley , Roth Lindsey M , Smith-McLallen Aaron , Stovall Ellen L. , Scholle Sarah Hudson 
Published: February 2017

281 Background: Patient experiences are an important component of quality, but information on how well oncology providers meet the specific needs of patients with cancer is limited. This study reports on the patient experiences among patients undergoing drug therapy treatment for cancer in diverse outpatient settings. Methods: We assessed patient experiences using a modified version of the CAHPS Survey for Cancer Caredeveloped by the American Institutes for Research.The survey has five composites and an overall rating of providers. We used claims data from an insurance plan in Southeastern Pennsylvania to identify all patients who had a paid claim for drug therapy treatment at 26 practices from January 1 through July 31, 2014. The survey was sent to 2,302 patients who met this criteria and 701 patients returned a completed survey for a response rate of 31%. We calculated scores of 0-100 on the composites after adjusting for age, education, self-rating of mental health and response tendency (a measure of level of optimism/pessimism). Results: In general, cancer patients rated their providers highly on patient experience, particularly on access and communication. However, cancer patients rated their providers lower on shared decision-making and helping patients manage their symptoms and care at home. The scaled, adjusted scores on the five composites were: Access (score=91; 95% CI=90-92); Affective communication (score=90; 95% CI=88-91); Exchanging information/keeping patients up to date (score=89; 95% CI=88-90); Shared decision-making (score=78; 95% CI=76-80); Enabling patient self-management (score=69; 95% CI=67-71). We encountered several challenges in fielding the survey related to attributing patients to specific practice sites, identifying patients who had died, and concerns raised by patients/family respondents about the length or content of the survey. Conclusions: Our findings suggest the need for strong efforts to engage cancer patients in decision-making and provide supportive care. Methodology for sampling patients using claims data needs to be more accurate and the survey could be edited for length and comprehension.
Setting quality improvement priorities for women receiving systemic therapy (ST) for early stage breast cancer (EBC) using population level administrative data.
Authors: Enright Katherine , Yun Lingsong , Gonzalez Alejandro , Powis Melanie , Taback Nathan , Booth Christopher M. , Trudeau Maureen E. , Krzyzanowska Monika K. 
Published: February 2017

299 Background: Routine evaluation of evidence informed quality measures (QM) can drive improvement in cancer systems by highlighting potential gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact on quality at a population level. We aimed to use variation in performance to set priorities for improving the quality of ST for women with EBC. Methods: EBC cases diagnosed 2006 – 2010 in Ontario, Canada were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. A panel of QMs, previously developed to be operationalized for administrative data, was applied to reflect the quality of ST. Each QM was evaluated in all patients who met the inclusion criteria for the individual measure. QMs were ranked based on institutional variation in performance using the mean absolute difference (MAD). Results: We identified 28,303 patients, treated at 84 institutions. The performance of each QM is listed in Table 1. Timely receipt of ST, febrile neutropenia (FN) secondary prophylaxis, emergency room visits or hospitalizations, receipt of hormonal therapy (HT) and the use of surveillance imaging represented the 5 QM that demonstrated the greatest variation. Conclusions: Considerable institutional-level variation highlights potentially actionable areas of improvement [Table: see text]
Estimating the cost-savings of a comprehensive hospital-based palliative care program.
Authors: Isenberg Sarina , Lu Chunhua , McQuade John P , Smith Thomas J. , Razzak A. Rab 
Published: February 2017

2 Background: In FY 2012, Johns Hopkins Medicine (JHM) established a palliative care inpatient unit (PCU). The PCU received patients as transfers and direct admissions. PCUs can improve care (Roza K, et al. JPM 2015) and lower per diem costs compared to usual care (Smith TJ, et al. JPM 2003; Goldstein J, et al. JPSM 2015). This project studied the financial impact of the PCU and PC program on JHM. Methods: Using one fiscal year of admissions, the team calculated the per day variable cost of pre-transfer in to palliative care (from ED) and palliative care transfer. These fees were multiplied by the number of patients transferred to the PCU (153) and by the average length of stay in the PCU (5.11 days). These variable costs were added together to reach the combined savings. Consultation savings were estimated using established methods (Morrison RS, et al. Arch Int Med 2008; adjusted to 2014 dollars). Results: The PCU operated at 54% occupancy in the first year. The daily loss pre-transfer of $1,672 was reduced 59% to $785 post-transer. Over 60% of transfers came from the ICU, freeing beds. The PCU saved JHM $367,751 in direct costs; additional cost savings for PC consultation were estimated at $4.3M (1,335 live discharges × $2,374, 165 decedent discharges × $6,872) and $370,000 was collected in professional fees, for a total contribution of approximately $5M. Conclusions: The PCU and PC program had a favorable impact on the health system. As JH moves to an acountable care organization model being both provider and insurer, such improved quality, cost savings, and increased ICU availability are desirable.
The well-being of long-term cancer survivors.
Authors: Sullivan Jeffrey , Thornton Snider Julia , van Eijndhoven Emma , Batt Katharine , Okoro Tony , Shah Manan , DeLeire Thomas 
Published: February 2017

30 Background: While numerous studies have examined the outcomes of individuals recently diagnosed with cancer, less is known about the well-being of long-term (LT) cancer survivors. Methods: Using the Health and Retirement Study (HRS), a nationally representative survey of US residents over age 50, we defined four cohorts: US residents over age 50, individuals recently diagnosed with cancer (≤4 years from diagnosis), LT cancer survivors (>4 years from diagnosis) and individuals with a chronic condition (diabetes, heart disease, hypertension, lung disease or prior stroke). We compared well-being measures across cohorts. We imputed total medical spending using the Medical Expenditure Panel Survey and the Medicare Current Beneficiary Survey. Results: We identified 22,034 US residents over age 50; 754 individuals recently diagnosed with cancer; 1,764 LT survivors; and 12,874 individuals with chronic illness. Over the biannual survey waves from 2004-2012, this amounted to 22,034; 3,880; 8,480; and 57,363 person-years, respectively. (The 50+ cohort was analyzed in 2010, the most recent year in which the HRS was nationally representative.) Given the large samples, most differences between LT survivors and other cohorts were statistically significant (p<0.05). However, LT survivors’ outcomes were often closer to those of individuals with chronic illness than to the recently diagnosed. Earnings if employed of the recently diagnosed and self-reported health of the chronically ill were not significantly different from LT survivors. Conclusions: Although cancer has a negative impact on well-being in the short term, over time cancer survivors’ well-being improves, becoming more similar to that of individuals with a chronic condition. [Table: see text]