bluuebunny/crossref_metadata_2025_split huggingface dataset:
What is the real rate of surgical-site infection?
Authors: Taylor Jolyn Sharpe , Marten Claire , Potts Kimberly , Cloutier Lynn , Cain Katherine , Fenton Shauna , Tatum Tara , James Deepthi , Hubbs Cheryl , Burzawa Jennifer , Vachhani Shital , Nick Alpa Manchandia , Meyer Larissa , Graviss Linda , Ware Kathy , Park Anne , Aloia Thomas A. , Bodurka Diane C. , Levenback Charles F. , Schmeler Kathleen M. 
Published: February 2017

171 Background: Surgical site infections (SSI) are associated with patient morbidity and increased healthcare costs. Although several national organizations monitor SSI including the University Health System Consortium (UHC), National Surgical Quality Improvement Program (NSQIP), National Healthcare Safety Network (NHSN) and Agency for Healthcare Research and Quality (AHRQ), there is no standard reporting methodology. We compared SSI rates from these databases to our own chart review. Methods: We queried the UHC, NSQIP, NHSN and AHRQ databases from 7/2012-6/2014 for SSI following gynecologic surgery at our institution. UHC and AHRQ rely on ICD-9 coding while NSQIP and NHSN employ trained reviewers. Each organization uses different definitions, inclusion and exclusion criteria for SSI. NSQIP reviews 13-17% of cases at our institution while the other agencies include all cases. The rate of SSI was also obtained from chart review for 5/1/2014-6/30/2014 with SSI defined as an infection of the surgical incision or organ space requiring antibiotics. SSI was classified as superficial, deep or organ space (OS). The rates reported by the agencies were compared to the rate obtained by chart review using Fisher’s exact test. Results: The combined UHC/NSQIP/NHSN/AHRQ SSI rate was 5.1% (78/1,540) while the rate found by chart review was 12% (20/166) (p = 0.001). Overall SSI rates for the databases were: UHC 1.6%, NSQIP 8.8%, NHSN 2.9% and AHRQ < 1%. The combined database reported fewer superficial SSI compared to investigator chart review but did not differ significantly when reporting deep and OS: superficial 1.6% v 7.8% (p < 0.001), deep 2.1% v 1.2% (p = 0.57) and OS 2.9% v 3.6% (p = 0.26). The individual databases had wide variation in rate of superficial (UHC 0.7% NSQIP 1.2% NHSN 0.5% AHRQ 0%), deep (UHC 0.7% NSQIP 4.7% NHSN 1.3% AHRQ 0%) and OSI (UHC 0.03% NSQIP 4.4% NHSN 1.4% AHRQ < 1%). Only 19 cases (24.4%) were included in > 1 database. Only one case was included in three databases (1.3%) and no cases were included in all four. Conclusions: There is discordance among national reporting agencies tracking SSI and all agencies reported a different rate of SSI compared to chart review. Adopting standardized metrics across agencies could improve consistency and accuracy in assessing SSI rates.
Discussions of cancer screening: What do physicians say, what do patients hear, and how much shared decision making occurs?
Authors: Talcott James Austin , Aharonoff Gina , Bezuhly Maureen , Herzstein Jessica , Osborne Michael P. , Fowler Floyd Jackson 
Published: February 2017

180 Background: Like other medical interventions, cancer screening requires shared decision-making (SDM). To better understand the process, we are performing a cluster-randomized trial of educational supports to improve screening guideline compliance for breast, cervical, colorectal, lung and prostate cancer at two urban academic medical centers. We present interim results that focus on recalled SDM discussions. Methods: We are enrolling an age- and sex-stratified sample of 216 patients aged 30 to 89 years, 18 treated by each of 12 primary care physicians at two affiliated hospitals before a periodic physical examination. Screening guideline format (color-coding) and academic detailing are independently assigned to providers. Patients and providers are surveyed immediately after the encounter to document SDM discussions, recommendations and beliefs. Screening guidelines (recommended, not or controversial) were determined by age, sex and risk factors. Results: The first 107 eligible enrolled patients were racially diverse (non-Hispanic Caucasian 65%) and well educated (college grad 84%). Patient-physician disagreement about whether screening had been discussed ranged from 6% (mammogram) to 36% (cervical cancer) and disagreement about whether the screening test had been recommended ranged from 17% (mammography) to 44% (PSA). In only 24 (12%) of 159 jointly recalled screening discussions did both patients and physicians agree that all 3 elements of SDM – reasons for screening, reasons against and that it is optional – were discussed, although patients and physicians separately reported all elements in 58 (36%) and 45 (28%), respectively. Conclusions: Even immediately after the encounter, many patients and physicians recalled whether screening had been discussed and recommendations differently, and most SDM discussions were incomplete. Clinical trial information: NCT02430948.
Prevalence and predictors of second opinions from medical oncologists for early-stage breast cancer: Results from the iCanCare study.
Authors: Kurian Allison W. , Friese Christopher Ryan , Bondarenko Irina , Jagsi Reshma , Katz Steven J. 
Published: February 2017

185 Background: A second medical oncology opinion (SMO) may facilitate chemotherapy decision-making. However, little is known about the interplay between SMOs, treatment decision-making and chemotherapy use. Methods: We surveyed women newly diagnosed with early-stage invasive breast cancer and treated in 2013-2014 (response rate 70%), accrued approximately 3 months after surgery through 2 population-based SEER registries (Georgia and Los Angeles), about their experiences with medical oncologists, decision-making, and chemotherapy use. We evaluated demographic, clinical and decisional factors associated with SMO using logistic regression, and evaluated the association between SMO and chemotherapy, adjusting for clinical indication for chemotherapy, results of the 21-gene recurrence score assay, and estimated propensity for SMO given patient and tumor-specific characteristics. Results: Among 1182 insured patients who consulted any medical oncologist, 8.7% had SMO and 2.4% received chemotherapy from the SMO provider. On multivariable analysis, predictors of SMO use were younger age (odds ratio, OR 0.97 per year, 95% confidence interval, CI 0.94-0.99), education (college vs. high school graduate, OR 1.88, CI 1.06-3.33), an intermediate 21-gene recurrence score (OR 2.21, CI 1.18-4.16) and a variant of uncertain significance on BRCA1/2 gene testing (OR 5.61, CI 1.22-25.72). Satisfaction with chemotherapy decision-making was high and did not differ between patients who did vs. did not receive SMO (85.3% quite or totally satisfied vs. 86%, p-value 0.85). On multivariable analysis, chemotherapy use did not differ between SMO recipients vs. non-recipients (p-value 0.25). Conclusions: SMO use was low among early-stage breast cancer patients, and was not followed by more or less receipt of chemotherapy. High decision satisfaction regardless of SMO use suggests little unmet demand. Along with younger age and more education, the factor that predicted SMO use was uncertain results of genomic testing. Studies of precision medicine should track patients’ demand for SMO, which may rise with the dissemination of increasingly complex genomic tests. Funding: P01-CA-163233
Is there a relationship between self-reported healthy days and comorbidity medication adherence among oncology patients?
Authors: Casebeer Adrianne Waldman , Drzayich Jankus Dana , Hopson Sari , Khoury Raya , Parikh Aparna , Stein Alisha , Michael Todd , Stemkowski Stephen , Bunce Mikele 
Published: February 2017

189 Background: Previous studies established the link between comorbidities and Health Related Quality of Life (HRQoL) for cancer patients. Adherence to comorbid medications has been found to be predictive of HRQoL in other disease states, but this has not been established for patients with cancer. This study sought to investigate the association between healthy days (HDs) and comorbidity medication adherence (CMA) for cancer patients. Methods: A survey was mailed to 5,098 patients with metastatic breast, lung or colorectal cancer who received treatment in 2014 and had at least one comorbid condition. Survey responses were merged with Humana claims data for analysis. The CDC’s Healthy Days measure was used to identify self-reported overall, physical and mental unhealthy days in the past 30 days and the number of days that poor physical or mental health limited usual activities. The Morisky Medication Adherence 8-point scale was used to differentiate high CMA ( > 6) and low CMA ( < 6). P-values are from chi-square and t-tests. Results: The survey response rate was 32% (N = 1,629). Respondents were mostly female (66%), and Medicare beneficiaries (90%) with mean age of 69.7 years. Patients with lung cancer experienced more overall unhealthy days than those with either breast or colorectal cancer (mean: 16.2 vs 12.6 and 13.5, p < 0.0001). The number of overall unhealthy days was higher among patients with low CMA compared to high CMA (mean: 15.4 vs 13.5, p = < 0.0001). Patients with low CMA had more mentally unhealthy days than those with high CMA (mean: 6.0 vs 8.2, p = 0.0128). There was no difference in physically unhealthy days by CMA. Patients with low CMA had 3.7 more unhealthy days that kept them from doing their usual activities (12.0 vs 8.3, p< 0.0001). Conclusions: Surveyed oncology patients with high comorbidity medication adherence reported fewer unhealthy days, in particular mentally unhealthy days, in the past 30 days. The complex interplay between comorbidity medication adherence and HDs for cancer patients warrants further investigation. These results suggest that increasing patients’ level of comorbidity medication adherence may be an avenue for improving the number of healthy days they experience.
Do perceived barriers to lung cancer screening differ between attending physicians and residents?
Authors: Greenwood-Hickman Mikael Anne , Jones Laura , Marsh Katie , Rivera M. Patricia , Molina Paul , Reuland Dan , Bowling J. Michael , Birchard Katherine , Maygarden Susan , Henderson Louise 
Published: February 2017

192 Background: In February 2015, legislation went into effect requiring Medicare to cover lung cancer (LC) screening with low dose computed tomography (LDCT) for high risk patients. Despite this, much debate and uncertainty exist among physicians about LC screening best practices. We aim to compare perceived barriers to LC screening between resident and attending physicians in Family and Internal Medicine, two departments selected for their high likelihood of seeing patients eligible for LC screening. Methods: Between February and July of 2015, a 23 question Qualtrics survey was conducted among physicians and residents at a large academic hospital to assess knowledge and beliefs of LC screening. In the Family and Internal Medicine departments, we surveyed 100 residents (30% response rate) and 86 attendings (49% response rate). Responses from the two departments were combined and stratified by attending or resident status. Results: Most respondents were White and non-Hispanic. Attendings were older (mean age 47, range 32-64) and mostly male (54%), while residents were younger (mean age 30, range 28-35) and mostly female (63%). The majority of attendings (62%) and residents (78%) agreed that limited time during patient visits requires presenting problems take priority over LC screening. Other barriers cited by both groups included cost to patients (74% attendings and 83% residents), potential for complications (53% and 70%), and too many false positives (67% and 73%). Over half of both groups agreed that inconsistent recommendations make it difficult to decide whether or not to screen for LC. In addition, the majority of both groups indicated that they were undecided about the benefit of LC screening for patients (43% attendings and 55% residents). No statistically significant differences were found. Conclusions: Regardless of resident or attending status, respondents identified inconsistent recommendations, time restrictions during visits, cost to patients, potential complications, and a high false positive rate as barriers to LC screening. Both groups reported being undecided about the utility of LC screening. These findings suggest a need for alternative strategies for future LC screening implementation.
Quality improvement strategies in medical oncology: A qualitative analysis from a scoping review.
Authors: Franco Bryan B. , Dharmakulaseelan Laavanya , Singh Simron , Haynes Adam E. , Wong Brian M. , Cheung Matthew C. 
Published: February 2017

203 Background: In 2001, the Institute of Medicine (IOM) outlined imperatives to improve quality of care. Quality improvement (QI) has since become essential to cancer care but barriers still exist to the publication of and participation in QI initiatives, including limited recognition for QI and uncertainty with methodologies. We sought to identify strategies used in QI in scholarly medical oncology literature to provide practical guidance for QI. Methods: We conducted a scoping review using Arksey and O’Malley’s framework. A search of EMBASE and MEDLINE databases found 48,186 unique English citations published between January 2001 and August 2014. We utilized an iterative process to refine the inclusion criteria and two reviewers independently reviewed abstracts, resulting in the inclusion of 270 articles. The reviewers then extracted text segments relevant to QI strategies. A qualitative content analysis approach was used to accurately analyze and summarize this process-oriented data. Results: Fifty-four unique QI strategies identified were used alone or in combination to improve structures or processes of care. Five content categories of strategies that targeted structures of care emerged: 1) more methodical approaches (eg, lean thinking, supply-demand analyses), 2) participatory action research and similar strategies, 3) infrastructure to promote health care provider collaboration, 4) application or improvement of information technology (IT), and 5) progression towards a systematic assessment of all patients’ needs. We identified three categories of QI strategies for processes of care: 1) improving patient-clinician relationships or communications, 2) care navigation, and 3) telehealth. Conclusions: Our review identifiedQI strategies in published literature. Strategies were consistent with and expanded on the IOM’s redesign imperatives such as effective use of IT, development of better teams, and care coordination. Identification of strategies provides professionals with tools to engage in QI and may encourage support and recognition for QI. Future studies should examine the impact of different QI strategies on outcomes of care in oncology.
Initiative to streamline clinical trials (ISCT): Guidance for academic investigators/sponsors.
Authors: Grant Jasmine , Brodeur-Robb Katherine , Urton Alison May , Bosch Jacqueline , Seymour Lesley , Arts Karen E. 
Published: February 2017

219 Background: The 2011 Canadian Cancer Research Alliance (CCRA) report on the State of Cancer Clinical Trials in Canada outlined in detail the threats to the conduct of academic oncology clinical trials caused by increasing complexity and workload resulting from a perceived onerous regulatory environment. The report recommended engaging Health Canada and key stakeholders to foster agreement in appropriate interpretations of the Canadian Food and Drug Regulations Part C Division 5 and ICH Good Clinical Practice (GCP) guidelines. Methods: The ISCT Working Group (ISCT WG) was formed in 2012 to address the CCRA recommendations for academic clinical trials and include experts from multiple therapeutic areas. The primary objective of the ISCT is to develop specific, practical interpretations of current regulations, laws and guidelines to facilitate Canadian clinical trials. Feedback was obtained from interested parties and ISCT members by means of surveys, face-to-face meetings and conference calls. Results: The major areas of concern identified include Health Canada Clinical Trial Applications, Investigational Product supply, monitoring, oversight of equipment and facilities, delegation of duties, validation of electronic systems, source documents and records retention, trial costs, the consistency of interpretation by different divisions of Health Canada, and access to related resources. A subcommittee was established for each area identified above and a series of recommendations to streamline processes with a focus to reduce regulatory burden for academic clinical trials. The ISCT WG used other relevant documents including the OECD framework and FDA Guidance on Risk Based Monitoring to inform its work. Conclusions: The final recommendations of the ISCT have been provided to all stakeholders, presented at international conferences and published on the N2 website. Canadian academic sites have used guidelines during Health Canada inspections with success. Future goals include an ISCT Workshop for academic site leaders to facilitate implementation of the ISCT guidelines, continue to address areas of concern, and track the success of the recommendations in ameliorating the conduct of academic trials.
Establishing an oncology quality dashboard for improvement.
Authors: Denny Diane , Gross Danielle 
Published: February 2017

223 Background: Cancer Treatment Centers of America (CTCA), a national network of five hospitals, formed a Quality Improvement Committee to bring together both clinical and administrative leadership (physician, nursing, pharmacy and quality) across the enterprise vested in the oversight of quality and patient safety. Tasked with facilitating and driving measurement and improvement the group established a Quality dashboard housing metrics of importance given current performance, evidence-based practice, and evolving external standards. The dashboard includes a mix of outcome, process, and structure measures with targets, both externally driven and CTCA established. Methods: The dashboard houses data sourced from a multitude of systems and is segmented into clinically relevant categories such as Infection Prevention, Nursing, Medication Management, and Medical Oncology to name a few. These categories are further broken down into specific measures, reported by quarter, and color-coded (red/yellow/green) to display progress. Targets are established based upon external benchmarks, where data is available. Each metric is also graphically displayed, trending the 6 most recent quarters of data as another visual reference. Finally, a glossary was created to standardize key measure details across the enterprise for accurate data collection including documentation of source, numerator, denominator, references, inclusions, exclusions and rationale. Data is updated monthly to reflect most current performance and promote timely intervention. Results: Since development of the Quality dashboard, CTCA has experienced various red to yellow to green progressions as well as upped its targets indicating significant advancement in performance. Standard data collection and visual identifiers within one repository has enabled CTCA to accurately focus time and resources where needed in order to continually improve care. Conclusions: The establishment of the enterprise-wide quality dashboard has led to great collaboration within CTCA’s network of hospitals. The display of the data allows both a focus upon individual and network strengths and opportunities for improvement as well as a mechanism for communicating shared goals.
Optimizing discharge teaching process to increase the efficiency and effectiveness of the follow-up call.
Authors: Kaufman Laurie , Aranzamendez Gina , Hayes Beverly A , Pathak Kavita , Rohe Duke , Haywood Valerie 
Published: February 2017

226 Background: Patients undergoing complex oncologic operations are at high risk for perioperative complications associated with adverse effects on quality of life, costs and overall outcomes. Complications within 30 days of discharge are most commonly identified during first 48-72 hours post-discharge. Telephone follow-up can provide a safety net and is part of a larger discharge teaching process. Initial review of the current follow up processes underscored many variations. An interdisciplinary team was tasked to optimize discharge processes across the continuum of care which leads to a more efficient follow-up call encounter. Methods: Working with in and outpatient frontline staff from focus group teams, pre and post implementation work flow processes were captured. Inefficiencies were used for a redesign session to develop a standard discharge teaching guide and patient checklist. A database was used for data collection of measures for issues and complications encountered by patients. Storyboards were used to communicate the project progression to those working within the processes being redesigned. Results: A 42% reduction in inefficiencies of overall discharge teaching process was obtained with the largest decrease during the post discharge phase. The number of patients contacted during follow-up calls increased by 12%: discussions were longer and documentation took less time (excluding outliers). 46% of the issues were handled by the Clinical Nurse Leaders: all other medium/high issues were handed off to primary team. The time spent for follow-up calls increased, therefore, increasing direct labor cost. The rate of complications and severity decreased during the implementation phase. Effects on the readmission rates remains to be seen and patient satisfaction scores are showing a positive trend. Conclusions: Involving content experts to assess the discharge teaching process identified a worklist of inefficiencies. Using these to optimize the process, a discharge teaching guide and patient checklist were developed. Inefficiencies were reduced and process made more effective with an increased percent of patients contacted during the follow-up call.