bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of pharmacist integration in oncology clinics to identify and resolve moderate to major drug-drug interactions.
Authors: Seki Jack Toshimine , Hughsam Matthew , Krzyzanowska Monika , Lo Aaron , Ng Pamela , Sridhar Srikala S. , Tsang Dominic , Kukreti Vishal 
Published: February 2017

71 Background: Medication reconciliation (MR) in outpatient clinics has been under-evaluated. We postulated that cancer patients would benefit from MR done by a pharmacist as these patients have many care providers, many medications, and are at high risk of drug-drug interactions (DDIs). Hence, we conducted a quality initiative evaluating the role of a pharmacist in the ambulatory clinics. Methods: One pharmacist prospectively rotated amongst four oncology clinics four days a week from June 3 to September 18, 2008. The pharmacist performed MR, and as a consultant developed therapeutic plans related to drug therapeutic problems (DTPs) including adverse reactions and DDIs. Patient medication lists were retrospectively analyzed using Micromedex and DDIs were categorized by frequency, severity and evidence level. A monthly survey (Likert scale) evaluating pharmacist contributions to each clinic team was completed by physicians and nurses. Results: A total of 158 patients were seen in 227 patient visits. The pharmacist identified 141 DTPs in 60 patients across 74 visits. The most frequently observed were no drug for a medical problem (51.1%), dose too low (12.8%), wrong drug (9.9%), and adverse drug reactions (9.2%). In response, 174 therapeutic plans were made. The most frequently recommended actions were drug added (40.8%), dose changed (13.2%), drug discontinued (9.2%), and interval/duration changed (7.5%). A total of 414 DDIs were identified in 110 patients, across 149 patient visits. On average, 2.62 DDIs were reported per patient, and 1.82 DDIs per visit. By severity, 139 (33.6%) major, 258 (62.3%) moderate, 16 (3.9%) minor and 1 (0.2%) contraindicated DDIs were documented. By level of evidence, 46 (11.1%) DDIs were excellent, and 236 (57%) were good. Survey results showed that doctors and nurses agreed/strongly agreed that pharmacist presence was valuable. The most useful contributions identified were consultation regarding DDIs, adverse drug effects, and medication efficacy decisions. Conclusions: DDI rates are high and most are moderate or major in severity. There is a clear benefit from the integration of a pharmacist to the clinics with an improvement in patient safety and quality of care.
Using a statewide collaborative approach to improve tobacco cessation referral rates for cancer patients.
Authors: Severson Jane Alcyne , Baca Hilary , Blayney Douglas W. , Brown Karen , Galiyas Grayce , Minasian Mara , Notier Anna , Schmidt Joan , Warren Graham Walter 
Published: February 2017

74 Background: Tobacco use by cancer patients decreases the effectiveness of cancer treatment, increases treatment toxicity, increases the risk of developing a second primary cancer, and increases mortality. Stopping tobacco use may reduce many of these adverse effects in cancer patients. Methods: The Michigan Oncology Quality Consortium (MOQC) collaborated with the Michigan Cancer Consortium (MCC) to implement the Tobacco Cessation Demonstration Project. This entailed designing a standard workflow and other lean tools to assist oncology practices in referring all cancer patients who use tobacco to the free Michigan Tobacco QuitLine or other cessation services. 19 practices participated in three learning sessions during which the following were provided: education by subject matter experts, use of data management and lean tools, and the sharing of barriers and successes. Results: Examination of baseline MOQC Quality Oncology Practice Initiative (QOPI) data demonstrated that < 47% of patients who use tobacco were advised to quit or referred for tobacco cessation (n = 574 charts/44 sites), which was equivalent to the national QOPI mean in Fall 2012. Root cause analysis of this lack of action in tobacco cessation identified limited knowledge to the risks of continued smoking and the lack of available resources as barriers to adopting necessary change. Implementation of the MOQC/MCC Tobacco Cessation Demonstration Project increased total statewide referrals to the QuitLine by 30.9% over the first 2 months with an increasing proportion of patients (41%) being cancer patients referred by MOQC participating sites. Conclusions: Supplying scientific evidence, collaboration, and the use of lean tools improved the referral rate to a tobacco cessation program for oncology patients. [Table: see text]
Determinants of survivorship care plan implementation in U.S. cancer programs.
Authors: Birken Sarah , Mayer Deborah , Weiner Bryan , Deal Allison Mary 
Published: February 2017

78 Background: The Institute of Medicine recommended and many professional societies require survivorship care plan (SCP) use to facilitate cancer survivors’ transition from treatment to follow-up care. Rates of SCP adoption (plans to use SCPs) and implementation (current use) in US cancer programs remain unclear. Our objectives were to (1) assess rates of SCP adoption and implementation and (2) determine what distinguishes cancer programs that have implemented SCPs from those that have not moved beyond adoption. Methods: We surveyed employees knowledgeable about SCP adoption and implementation in a nationally representative sample of 100 US cancer programs. Data were analyzed using descriptive and bivariate statistics. Results: The response rate was 80%. Ninety-six percent of programs adopted SCPs, but only 45% implemented SCPs. Among programs that implemented, SCP use remains inconsistent: Use is restricted primarily to breast (81.58%) and colorectal (55.26%) cancer survivors; in 58.33% of these programs, less than a quarter of providers has ever used SCPs; and SCPs are seldom delivered to survivors or their primary care providers. Employees in many programs indicated that SCPs were adopted because of the belief that SCPs would improve care quality and the release of professional society guidelines; however, neither of these factors influenced SCP implementation. Few quality markers (e.g., NCI-designated program type; Commission on Cancer membership) influenced SCP implementation. Determinants of SCP implementation included teaching hospital program type (p = .04) and NCCCP membership (p = .009). Freestanding facility type had a negative relationship with SCP implementation (p = .02). Conclusions: Given inconclusive evidence of SCPs’ effectiveness in improving care coordination and patient outcomes, many scholars have recently advocated for research to promote SCPs’ effectiveness. These efforts may be in vain if SCPs are not more routinely implemented. Efforts should be targeted at enabling programs to implement quality improvement tools. Future research should determine what promotes SCP implementation among teaching hospitals and NCCCP members, and what inhibits freestanding facilities from implementing SCPs.
Bidirectional consultative process as a novel methodology to develop a pan-Canadian cancer quality initiative.
Authors: Mitera Gunita , Agent-Katwala Mary , Porter Geoffrey A. , Bryant Heather E. , Sullivan Terrence 
Published: February 2017

80 Background: To foster pan-Canadian quality improvement strategies in cancer diagnosis and treatment, a new publically funded opportunity was launched though a Request for Proposals (RFP). Methods to develop RFPs in the public health care sector are variable. To generate enthusiasm and ensure appropriateness and relevance of the RFP, a novel methodology was developed to refine and validate the focus of the RFP. Methods: An extensive multi-pronged bi-directional consultative process helped identify and engage with clinical experts, senior administrators, and other relevant stakeholders. In-person discussions with relevant stakeholders, an electronic stakeholder engagement survey, and two interactive electronic information sessions (Webinars) were included. The intent of the eBlast was to seek survey responses and also to build awareness of the upcoming opportunity. An eBlast engaged stakeholders and stakeholder networks for the electronic component of the bi-directional process. Secondary distribution encouraged wide-spread dissemination. The survey and recorded Webinar were publically posted online. Results: Approximately 30 in-person consultations occurred and the electronic survey and Webinar details were sent to approximate 1,000 individuals and external networks. 80 responses were received along with 76 Webinar attendees. Feedback was received from a representative cross-section of the Canadian quality community as measured by geographical distribution and discipline. There was general pan-Canadian agreement that the quality topic chosen was relevant and appropriate. Through this methodology refinements were made to finalize the organization and content of the RFP. Conclusions: When developing a national call for a publicly-funded quality improvement opportunity, it is imperative to ensure the topic considered is relevant, appropriate, and there is interest from stakeholders to apply. A bi-directional consultative process is a novel and economical method to ensure wide reaching engagement from relevant pan-Canadian stakeholders. This methodology can also be leveraged to refine and validate the final quality topic considered.
Breast cancer treatment delays in a majority minority community: Is there a difference?
Authors: Lathrop Kate Ida , Parsons Helen M. , Karnad Anand B. 
Published: February 2017

83 Background: Recent studies based from large nationwide cancer databases have consistently shown that Hispanic women with breast cancer have delays in treatment compared to non-Hispanic whites. However, time to treatment has not been studied in a community where Hispanics are the majority population. We hypothesized that Hispanic women in greater San Antonio will have no significant treatment delays compared to Non-Hispanic whites in the same community. Methods: We conducted a retrospective, observational study in 362 female breast cancer patients treated at a NCI designated cancer center with a largely Hispanic population. Using Kaplan-Meier analyses and multivariate Cox proportional hazards models, we examined the relationship between race/ethnicity and treatment delays including: 1) time from mammogram to biopsy and 2) time from biopsy to treatment, adjusting for patient demographics and cancer characteristics. Results: In our study, the majority of patients were Hispanic (50.0%, n=181). Hispanic patients were more likely to be obese, have estrogen receptor positive and higher grade tumors than non-Hispanic Whites (p ≤ 0.05 for all). After adjusting for a comprehensive set of socio-demographic and cancer characteristics, we continued to find no significant differences between race/ethnicity and time from mammogram to biopsy or time from biopsy to treatment (Table). Conclusions: Hispanic and non-Hispanic White women with breast cancer treated at our NCI designated cancer center have similar times to treatment. These findings suggest that minority status, as opposed to racial status, is an important risk factor for delays in breast cancer care. Future research should be focused on barriers imposed on minority groups within their community regardless of race. [Table: see text]
Development of a new oncology quality metric: The rate of evidence-based adherence.
Authors: Adelson Kerin , Holcombe Randall F. 
Published: February 2017

84 Background: The degree to which electronic health records enhance the quality of patient care depends on how the system is used to monitor and improve practice. In planning the transition to Epic’s electronic chemotherapy ordering platform, we saw an opportunity to increase evidence-based practice. Methods: Our Chemotherapy Council vetted more than 600 electronic protocols based entirely on published clinical trials and NCCN guidelines; modifications made to these protocols represent a divergence from clinical evidence. We examined the number of times the chemotherapy section of a protocol was modified before the first cycle to avoid counting dose modifications made for toxicities. To get the rate for the cancer center we calculated the # of discrete times all protocols were used (denominator) and the number of times all protocols were modified (numerator). We subtracted the ratio from 1 to reflect the proportion of protocols that were not modified. This ratio serves as a new quality metric – the Rate of Evidence-Based Adherence (REBA). REBA institution= 1 - Total # of modifications prior to first cycle for each protocol. The total # of uses of all protocols. Additionally, REBA can be used to examine disease group rates (REBA group), individual provider rates (REBA provider) and rates for individual protocols (REBA protocol). Institutions that have implemented evidence-based clinical pathways have strived for 80% (.80) adherence. We set this as our REBA benchmark. Results: The REBA institution was .86, higher than our pre-defined goal (p<0.001). There was wide variation in the REBA group (range 0.50-0.95). The REBA protocol identified two protocols (rates of .33 and .42 respectively) that were dose reduced the majority of the time. In the example of our Breast Group, the REBA provider, ranged from (.78 to .97) reflecting differing practice among 4 physicians. Conclusions: The REBA can identify faculty and disease groups who underutilize clinical evidence, facilitating feedback for quality improvement. The REBA protocol is a useful tool to identify specific chemotherapy templates that may need modification. The REBA is a powerful electronic tool, which can be utilized to monitor and enhance the rate of evidence-based practice in oncology.
Cancer care transparency: Trying to move the dial in California.
Authors: Teleki Stephanie 
Published: February 2017

85 Background: In 2012, approximately 140,000 patients (more than 16 new cases each hour) were diagnosed with cancer in California. Yet there is little useful information about the quality of cancer care to help patients, providers and payers make decisions about care. Methods: In 2012, the California HealthCare Foundation, an Oakland-based independent nonprofit philanthropy, launched an initiative focused on improving cancer care quality measurement and public reporting in the State. Since then, the Foundation has funded a number of projects aimed at filling information gaps: development of an interactive map and reports with data about the variation of care for breast and prostate cancer in California using State discharge and registry data (May 2013); development of a Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience of cancer care survey instrument (with NCI and AHRQ, in progress); exploratory analytic work to determine the feasibility of measuring and reporting the number of cancer procedures performed by hospitals using State discharge data, for procedures where there is an established volume-outcome link (with Stanford University, in progress); exploratory analytic work to determine the feasibility of measuring cancer care quality at the medical group level in California (with Integrated Healthcare Association; in progress); a report on cancer care spending in California (with Dana Farber, in progress). Results: Significant challenges exist at the state level to provide information for improved decision-making about cancer care. Among them: access to data, especially cancer registry data that importantly includes detailed diagnostic information; lack of clinical outcome and patient experience measures; time needed to engage partners; and costs of carrying out quality measurement projects. Conclusions: This presentation would review efforts underway in California, providing a view of the challenges and opportunities at the state level for cancer quality measurement and public reporting. This presentation could be conceived as part of an interactive break-out session with 1-2 other panelists with real-world experience.
Limitations of QOPI end-of-life (EOL) data use for purposes of accountability: Comparison of sample versus full cohort analysis.
Authors: Dalby Carole Kathleen , Catalano Paul J. , Donohue Caitlin C. , Bryar Julie M. , Norden Andrew David , Kostka Judith , Jacobson Joseph O. 
Published: February 2017

87 Background: Quality Oncology Practice Initiative (QOPI) retrospectively collects process measures at the practice level. Sample size is determined by number of full-time equivalent physicians. Although intended as an improvement program, there is growing pressure to use QOPI for accountability. Methods: We investigated QOPI sampling strategy for EOL measures in a large three-site community oncology practice for all patients meeting QOPI sampling criteria. Analysis period was July 1 to December 31, 2012. We included all patients submitted for the QOPI EOL module and compared the QOPI sample to the full but non-QOPI cohort using Fisher’s exact test. To assess relative precision, we calculated rates and 95% confidence intervals (CI) for the sampled vs. full cohorts (inclusive of QOPI cohort). Results: 246 deaths were analyzed, with 34 (13.8%) from the QOPI sample. No statistically significant differences were found between sampled and full non-QOPI cohorts. However, sampling was associated with wide CIs compared to precision using the full cohort (Table); e.g. #38 yields a CI width of 24.2% QOPI vs. 4.9% full. Similarly, #47 shows CI width of 27.7% vs. 9.0%. Low statistical significance yet wide CIs indicate comparison data are representative but with variability in precision. Conclusions: Although no statistically significant differences were identified, comparing QOPI sampling strategy to full cohort yielded presence of marked differences in precision. We suggest caution in use of current QOPI EOL sampling strategy if used for purposes other than improvement. [Table: see text]
A national survey: The patient’s perspective of gaps in the cancer treatment experience.
Authors: Lis Christopher G. , Patel Kamal , Rodeghier Mark , Rogers Mark , Gupta Digant 
Published: February 2017

90 Background: There are expected to be an excess of 1.6 million new cancer cases in the US in 2013. Recent emphasis has shifted to patient-centered care. However, data is lacking on what oncology patients value in their care. We therefore conducted a national survey to evaluate patient experience with service quality. Methods: An online survey was conducted in a national random sample of 1000 cancer patients in Aug-Sept 2012. Importance of 15 service quality items was measured on a 5-point Likert scale ranging from “not at all important” to “extremely important”. Patient experience with those 15 service quality items was captured as a yes/no response. Patient satisfaction was measured on a 5-point Likert scale ranging from “completely dissatisfied” to “completely satisfied”. Results: The top 3 areas of gaps between importance and experience were ‘having a specific individual to coordinate care’ (32%, p < 0.01), ‘after-treatment care and support’ (15%, p<.01) and ‘the presence of an integrated care team’ (15%, p<0.01). Among respondents who rated these areas as very/extremely important, only 43%, 65% and 75% experienced it, respectively. Conclusions: These national findings illustrate a significant void between patients’ desires and care delivered. This survey demonstrates the emphasis patients put on the need for more coordinated cancer care, after-treatment care and an integrated approach. [Table: see text]
Factors related to end-of-life (EOL) chemotherapy in solid tumor (ST) patients.
Authors: Rodriguez Maria Alma , DeJesus Yvette A , Cheng Lee , Buzdar Aman , Burke Thomas W. 
Published: February 2017

92 Background: Quality performance measures for cancer care, including use of chemotherapy in the last two-weeks of life, will be required for reporting. In this study, we evaluated the use of chemotherapy in ST patients (pts) within 14 days of EOL relative to several factors that may influence this practice. Methods: Adult pts (≥18 years) treated for ST at our institution, deceased December 01, 2010 through May 31, 2012, were retrospectively studied. Data on demographics, chemotherapy (excluded: hormones) within 14 days EOL, comorbidities, and cancer diagnoses were from administrative databases. Logistic regression analysis was performed for association of EOL chemotherapy with age, gender, ethnicity, comorbidities, cancer types, and metastatic status. Results: 5,607 pts met study criteria: median age 64 years; 48% female; 76% metastatic disease. EOL chemotherapy frequency was 3.9% overall, 4.6% in metastatic disease versus 1.7% in non-metastatic disease (p<0.01). Of 23 patients who received chemotherapy and had non-metastatic disease, the major tumor sites were: brain/other nerve system (34.8%) and lung/bronchus (21.7%).The top 10 frequencies in chemotherapy use by tumour sites were: melanoma (6.7%), female breast (5.5%), lung and bronchus (4.9%), pancreas (4.2%), brain/other never system (3.9%), head and neck (3.8%), female genital system, excluding ovary (3.4%), ovary (3.2%), liver/intrahepatic bile duct (3.0%), colon and rectum (2.6%). By regression analysis, the factor statistically significantly associated with receiving chemotherapy was metastatic disease (odds ratio [OR], 3.29; 95% CI,1.96-5.54), while factors associated with significantly less treatment were age ≥ 65 (OR, 0.66; 95% CI, 0.49-0.90); and any comorbid conditions (≥1 versus 0) (OR, 0.58; 95% CI, 0.38-0.89). Conclusions: A small portion of ST patients who died received EOL chemotherapy (3.9%). However, metastatic disease and diagnosis category influenced treatment. Melanoma and breast cancer patients had higher frequency of EOL treatment. Older age and comorbidities were associated with less treatment. Variation in EOL treatment of ST patients is thus influenced by several clinical factors, but did not seem influenced by gender or ethnicity factors.