bluuebunny/crossref_metadata_2025_split huggingface dataset:
SMART chemotherapy: A comprehensive cancer center’s journey to shared medical appointments.
Authors: Prescott Lauren S. , Dickens Andrea S. , Guerra Sandra L. , Tanha Jila , Phillips Desiree G. , Lowe Kathryn B. , Lozano Garcia Miguel A. , Soliman Pamela T. , Garcia Elizabeth A. , Lang Kai E. , Lewis-Patterson Paula A. , Levenback Charles F. , Bodurka Diane C. 
Published: February 2017

135 Background: Shared medical appointments (SMA) offer a novel approach to improve efficiency and quality of care consistent with the goals of the Institute of Medicine. To our knowledge, there are no established SMA models for oncology patients undergoing treatment. Our objective was to develop and implement a SMA for chemotherapy education and clearance for women with gynecologic cancer. Methods: We first assessed the level of interest in SMAs among our patients and providers through qualitative interviews. We subsequently created a multidisciplinary team comprised of physicians, mid-level providers, nurses, pharmacists, administrators, health education specialists and members of the QI Department. Our project consisted of several phases: 1) provider buy-in, 2) program development, 3) staff education, 4) implementation; and 5) patient recruitment. A plan-do-study-act cycle was performed following each SMA, using patient and provider feedback. Appropriate modifications were made before the subsequent SMA. Results: Both patients and providers identified pre-chemotherapy as an optimal area to pilot SMAs. We established a multidisciplinary Shared Medical Appointment and Readiness Teaching (SMART) clinic for all gynecologic oncology patients initiating chemotherapy with platinum- and taxane-based regimens. This model of care provides patient education within a framework of social support that empowers patients. We developed a standardized chemotherapy education presentation, and also provided patients with a tool kit that consisted of chemotherapy drug education, a guide to managing side effects, advanced directives and center contact information. Surveyed patients reported being highly satisfied with the group visit and would recommend SMA to other patients. Our preliminary data analysis revealed that SMART visits decreased wait time and increased value-added time for patients. Conclusions: SMAs for oncology patients initiating chemotherapy is both novel and feasible. A patient centric model, collaboration of multidisciplinary team members, and timely responsiveness to constructive feedback are essential to the successful integration of SMAs in an academic center.
Implementation of Sarah Cannon national and international multidisciplinary cancer tumor boards: Initial results.
Authors: Geer Richard J. , Kennedy Andrew S. , Burris Howard A. , Dugger Crystal , Lemaistre Charles Fred 
Published: February 2017

138 Background: Optimal cancer care is achievable when input is available from specialists in all related disciplines. To exploit the breadth and depth of clinical expertise within a large healthcare network, regularly scheduled web-based multidisciplinary tumor boards related to complex GI and breast cancers have been established. Methods: Monthly national and quarterly international multispecialty tumor boards were held in 2014. Each center presented a case for discussion and suggested management on a predetermined solid tumor subtype or clinical scenario. A web-based interface was used to show key information to the group in real time, including imaging, pathology, and laboratory results. Subspecialty participation included well known centers of excellence in radiation oncology, medical oncology, clinical research, surgical oncology and interventional oncology. A process to assure HIPPA compliance was implemented, and CME awarded. Results: Sarah Cannon centers in Nashville, Kansas City, Denver, San Antonio, Austin and London participated. An average attendance of ten physicians per center (range 4-18) was seen. Survey results demonstrated significant value as reported by participants in improving patient care leading to the development of a prospective clinical trial in one instance. Therapeutic options not available in the US but offered in the London center were discussed and a mechanism for direct referral to the London facility was developed. Improved rates of breast conservation (18% increase), breast reconstruction (31% increase) and use of AJCC staging (24% increase) were the product of breast conferences in each market. Conclusions: Physicians overwhelmingly supported and valued multidisciplinary tumor boards for GI and breast cancers. Consensus development, sharing of best practices, and promotion of the latest evidence based management led to changes in patient care. Additional centers will be invited to join meetings this year, with planned expansion to initiate similar meetings in blood and thoracic malignancies.
Costs and outcomes in stage IV non-small cell lung cancer at an urban safety net hospital.
Authors: Lel Julian , Folefac Edmund , Zaner Ken Scott , Hartshorn Kevan L. 
Published: February 2017

14 Background: Stage IV NSCLC is an incurable illness with significant morbidity. Chemotherapy prolongs average survival from 6 to 10 months and targeted therapies further reduce morbidity and prolong survival. These advances pose financial challenges for safety net hospitals, which may also disproportionately feel the impact of racial disparity. Outcomes in advanced lung cancer may thus differ in the underserved population and resources may not be allocated optimally. Methods: A retrospective review was conducted on all patients diagnosed with Stage IV NSCLC between 2005 and 2011 at Boston Medical Center, an urban safety net hospital. Data were collected on survival from time of diagnosis, type and duration of treatment, utilization of healthcare resources, as well as detailed personal characteristics. We calculated costs of treatment for all patients. We assessed the effect of treatment and patient characteristics on survival. Results: Of 198 patients analyzed, 57% were white, 32% were black, 6% were Hispanic. 11% were homeless. 57% did not receive antineoplastic therapy, 24% received cytotoxic chemotherapy, 18% received combined cytotoxic and targeted therapy. Median survival was 5.0 months without therapy, 7.0 months with cytotoxic chemotherapy and 9.2 months with combined therapy. Any therapy was associated with 56% longer survival. Hazard of death in white patients was 0.68 relative to non-white patients. Median total and monthly costs for patients on no therapy were $70,000 and $14,000, on cytotoxic chemotherapy were $112,000 and $19,000 and on combined therapy were $247,000 and $26,000. Cost per month of survival was $12,000 less for white patients and $15,000 more for homeless patients. Conclusions: The majority of patients did not receive antineoplastic therapy, despite robust survival gains associated with its use. Untreated patients nevertheless incurred a high cost of care. White patients showed better survival at a lower cost. Further topics for study and intervention in this population include barriers to therapy, early involvement of palliative and home-based care in patients not suitable for treatment, strategies for cancer care in the homeless, as well as closer inquiry into drivers of racial disparity.
Designing a multidisciplinary oral chemotherapy education and monitoring program.
Authors: Lane Sharon , Ng Kimmie , Sommers Robin , Dalby Carole Kathleen , Conley Susanne , Rizzo Patricia , Bagley Janet , Harris Christy , Fuller Frances , Nguyen Phuong , Szabatura Audrea 
Published: February 2017

146 Background: In 2013 ASCO and ONS published guidelines to promote safe practices for oral chemotherapy use. These agents can have significant toxicities and pose safety risks without proper adherence. Guided by the ASCO/ONS recommendations, Dana-Farber Cancer Institute (DFCI) designed a program to provide comprehensive patient education and adherence monitoring. Methods: To address patient safety risks associated with oral chemotherapy use, a multidisciplinary team assembled to design a process for timely and appropriate patient education and adherence monitoring. Physicians, Nurse Practitioners or Physician Assistants initiate education by reviewing the dosing schedule, side effects and providing a standard education sheet. Within 24 hours, a pharmacist contacts the patient and completes a teaching session utilizing a template based upon the MOATT Tool, a teaching tool developed by the Multinational Association of Supportive Care in Cancer. The MOATT Tool includes a review of the dosing schedule, side effects and management, drug handling, drug/food interactions and practice contact information for questions. Lastly, within five days of therapy initiation, a nurse calls the patient to reinforce education and to assess toxicity and adherence. To evaluate the effectiveness of the program, chart audits and patient satisfaction surveys were conducted. Results: To date 78% of patients started on oral chemotherapy have received a teaching session and 73% have received a follow up adherence call. Patient satisfaction surveys conducted demonstrate that 100% (N=12) of patients strongly agreed with the following statement; “following my counseling session with the Dana-Farber pharmacist, I understood how and when to take my oral chemotherapy medication(s)” and 94% agreed with the statement; “overall I feel that the oncology nurse phone session provided me with useful information.” Conclusions: Implementing a standard patient education and adherence monitoring program for patients initiating oral chemotherapy is essential to guarantee safe patient care. Compliance monitoring at the disease and provider level is necessary to ensure continual quality improvement.
A national strategy for quality and safety in radiotherapy: A comprehensive quality improvement approach.
Authors: Mitera Gunita , Kumar Eshwar , Parliament Matthew , Angers Crystal , Brundage Michael Donald , Drodge Suzanne , Gillan Caitlin , French John , Bird Louise , Bissonnette Jean-Pierre , Wilson Lianne , Brown Erika , Milosevic Michael 
Published: February 2017

148 Background: Canada utilizes a public payer, private health care delivery model, delegated sub-nationally. Effective coordination of uniform access to safe, high quality care can be challenging in this and similar international models. Quality improvement in radiotherapy (RT) involves approximately 50% of all cancer patients who will require RT during their illness. The Canadian Partnership for Quality Radiotherapy (CPQR) is a national quality improvement approach employing pan-Canadian engagement of a multi-disciplinary group of physicians, allied health professionals, administrators and patients. The objectives are to create a national culture of safe, high quality RT delivery for all patients; develop and implement a comprehensive sustainable national program for safe, high quality RT. Methods: All CPQR QA products/programs are processed using standard methodology of review and validation through community consultation, and endorsed by national stakeholders. QA products are incorporated into national QA guidelines and indicators for RT programs, technical equipment and patient experiences; integrating these into a national accreditation program; developing a national RT incident reporting and learning system. Active dissemination strategies use bottom-up and top-down approaches. Results: The national RT programmatic QA guidelines and key quality indicators were released in 2011 and 2013, with 3849 downloads. Approximately 50% of Canadian RT centres indicated implementing CPQR guidelines and changing local QA practices. 9 equipment QA guidelines were developed and validated, 6 are in development. National monitoring and learning structures are being developed through an accreditation program and incident reporting repository to be operated by national organizations for sustainability. Knowledge exchange activities included 26 presentations and 10 national/international invited discussions. A national systematic evaluation process will be executed shortly. Conclusions: CPQR’s national RT QA development and implementation approach is a successful model that can be adopted in other areas of healthcare considering system improvement.
Practice of venous thromboembolism (VTE) prophylaxis in hospitalized cancer patients at a comprehensive cancer center.
Authors: Rodriguez M.Alma , DeJesus Alma Yvette , Cheng Lee , Kroll Michael 
Published: February 2017

149 Background: VTE prophylaxis measures are endorsed by the National Quality Forum in alignment with quality indicators from the Centers for Medicare & Medicaid Services. Accordingly, documentation of VTE risk, prophylaxis measures, and contraindications are recommended for hospitalized patients. To standardize practice we embedded a VTE risk assessment and prophylaxis module into admission and post-surgical order sets (OS), starting August 15, 2011. Methods: A retrospective study of 9,065 cancer patients (≥18 years) admitted to The University of Texas MD Anderson Cancer Center between June 01, 2013 through September 30, 2013. Pharmacological prophylaxis was executed with low-molecular-weight heparin or unfractionated heparin. Mechanical prophylaxis was executed with graduated compression stockings and/or sequential compression devices. Chi-square testing was used to determine the association between categorical variables. All statistically significant levels were determined with P values < 0.05. Results: 7,366 (81%) of all hospital admissions had documented VTE risk assessment and prophylaxis through the standardized VTE module. Before implementation of the new OS, only 40% of eligible patients received an order for VTE prophylaxis. The majority of patients were designated high or moderate risk (91.1%). Patients with high risk were more likely to receive pharmacological prophylaxis than those with moderate risk (74.1% vs. 38.2%, P<0.01). The most frequent contraindications to pharmacological prophylaxis were major surgery with risk of bleeding and thrombocytopenia (Table). Conclusions: Most patients received VTE prophylaxis based on VTE risk levels presented in a standardized OS. There is is limited information in the clinical literature about the impact of VTE prophylaxis on outcomes among cancer patients, we plan to assess anticoagulation-related outcomes in this cohort of patients. [Table: see text]
Development of a medical record-based trigger tool for identifying adverse events during cancer care.
Authors: Lipitz Snyderman Allison Nicole , Pfister David G. , Anderson Christopher , Epstein Andrew S. , Killen Aileen , Sima Camelia S. , Atoria Coral L. , Fortier Elizabeth , Classen David , Weingart Saul 
Published: February 2017

152 Background: Adverse events for patients with cancer can be harmful and costly. Our understanding of these events and their associated harm for this patient population is limited. The objective of this study was to develop a medical record based trigger tool that can be used to help detect adverse events during cancer care. Methods: The trigger tool was developed using input from a multidisciplinary group of clinicians and researchers. First, clinicians from the study team, with input from specialists, compiled lists of adverse events that may occur during the receipt of cancer-directed treatment. Then, they created symptom-based or treatment-based ‘triggers’ that might indicate that the adverse event had occurred. From this list, the study team narrowed the triggers based on feasibility, frequency, severity of the associated adverse events, and overall expected usefulness. Additional feedback was obtained from an expert panel of nine clinicians outside the study team using a modified Delphi approach. The expert panel included representatives from medical oncology, radiation oncology, surgery, nursing, anesthesiology, general medicine, and emergency medicine. Feedback was summarized and the study team narrowed the list of triggers to create the final tool. Results: The final trigger tool for use in detecting adverse events during cancer care consisted of 76 triggers representing adverse events across organ systems. For ease of use, the tool was organized by general care, vital signs, medication related, labs, orders, and consults. Conclusions: From this study, we created a trigger tool to be used to detect key adverse events in cancer care, with an emphasis on those that may be preventable or for which the harm may be able to be mitigated. This information can be used to prioritize quality improvement activities, help to develop quality measures, and set relevant benchmarks for these events for cancer patients in order to improve the safety of cancer care.
Measuring chemotherapy appointment duration and variation utilizing real-time location systems (RTLS).
Authors: Barysauskas Constance , Hudgins Gina , Kupferberg Gill Katie , Camuso Kristen , Bagley Janet , Rozanski Sheila , Kadish Sarah 
Published: February 2017

154 Background: Clinical schedules drive resource utilization, cost, and patient wait time. Accurate appointment durations ensure appropriate staffing ratios to the daily caseload and maximizes scarce resources. Dana-Farber Cancer Institute (DFCI) adjusts infusion appointment durations for each chemotherapy regimen using a consensus method of experts including pharmacists, nurses, and administrators. Utilizing RTLS, we examined the accuracy of appointment duration compared to suggested duration. Methods: Appointment duration was calculated using RTLS in three disease centers at DFCI between August 1st and September 30th, 2013. Duration was defined as the amount of time a patient occupied an infusion chair. The top 10 administered infusion regimens were statistically investigated (n=805). Results: All median observed appointment durations were statistically different than the suggested durations. Appointment duration was shorter than scheduled 98% [C], 95% [I], and 75% [F] of the time and longer than scheduled 77% [A] and 76% [G] of the time. Almost all C and I appointments were more than 30 minutes shorter than scheduled. Among A appointments longer than scheduled, 56% were more than 30 minutes longer than scheduled. Conclusions: RTLS provides reliable and unbiased data to improve schedule accuracy. Replacing consensus with system-based data may improve clinic flow, relieve staff stress, and increase patient satisfaction. Further investigations should elucidate factors that cause variation in appointment duration. [Table: see text]
Using real time locating systems (RTLS) to redesign room allocation in an ambulatory cancer care setting.
Authors: Overmoyer Beth , Kadish Sarah , Haskett Courtney , Sanderson Kendall , Benneyan Jim , Reilly Christine , Pedulla Lillian Vitale , Brown Linda , Camuso Kristen , Bunnell Craig A. 
Published: February 2017

157 Background: Growing clinics need innovative ways to maximize capacity to ensure efficiency, a core element of quality care. Providers at the Dana-Farber Cancer Institute (DFCI) are assigned specific exam rooms for each clinic day. Despite room utilization below 50%, providers reported feeling constrained, and patients waited an average of 15 minutes to room. Furthermore, in February 2014, DFCI consolidated two facilities requiring that clinics absorb an immediate 10% increase in patient volume using available capacity. We sought to redesign the exam room allocation process by leveraging RTLS. Methods: Using computer simulation, we compared three options for allocating exam rooms. The simulation indicated a “pooled” room approach that did not designate rooms to individual providers would minimize patient wait time. A team was assembled to pilot the intervention in one clinic. An algorithm was developed to prioritize patients based on appointment time, arrival time, and provider availability. We utilized RTLS to automate the algorithm and indicate available exam rooms to coordinate transport of patients from the waiting area to exam rooms. Patient wait time was extracted from RTLS and compared between the baseline (provider-designated rooms) period and the post-intervention (pooled, undesignated rooms) period. Providers were asked post-intervention to provide feedback using a survey. Results: There was a significant decrease in the average wait to exam room despite a simultaneous increase in average appointment volume during the post-intervention period. Cumulative wait time gains averaged 3.3 hours daily. In addition, providers preferred the pooled rooming method over the designated rooming method. Conclusions: Allowing providers to utilize any available room has allowed this clinic to efficiently accommodate a larger number of appointments per day with an overall decrease in patient wait time. RTLS provided the real-time information necessary to succeed and drive improvement initiatives. [Table: see text]
Population-based economic impact of nab-paclitaxel plus gemcitabine in metastatic pancreatic cancer.
Authors: Milentijevic Dejan , Binder Gary , Whiting Scott , Penenberg Darryl Neil , Wei Xinyu , Kayitalire Louis , Renschler Markus Frederic 
Published: February 2017

16 Background: Increasingly, assessing the quality of cancer treatment involves scrutiny of both outcomes and economics, particularly for advances in areas where generic agents have been standards of care. With nab-paclitaxel plus gemcitabine (nab-P/G) demonstrating a significantly improved updated median overall survival in first-line metastatic pancreatic cancer (1mPanc) patients (pts) vs gemcitabine (G) monotherapy (8.7 vs 6.6 months), this analysis aims to estimate the economic impact for a US health plan population, from adding nab-P/G as a treatment option for this condition. Methods: A three-year budget impact model was constructed to estimate 1mPanc costs for nab-P/G, G, gemcitabine + erlotinib (EG), other G combinations (OG), and FOLFIRINOX (F), from a US health plan perspective in 2013 US dollars. Inputs for prevalence, drug, administration, G-CSF, and adverse events were derived from SEER, prescribing information, publications, 3Q2014 Medicare reimbursement rates, and other public sources. The model used 2013 patient treatment mix rates as reported by Cartwright et al (ASCO 2013) with nab-P/G growing to 25% by 2015. Results: A population mirroring the US age mix would have 7 pts with 1mPanc annually per 100,000 lives. Treatment mix for 2013 was 27% F, 8% nab-P/G, 51% G, 8% EG, and 6% OG. Total costs per course of therapy per patient (pt) are shown in table. Baseline (before nab-P/G) population costs per 100,000 lives were $111,400 ($15,914 per average pt). Adding nab-P/G to the treatment mix for 1mPanc added $6,083 to population costs ($869 per average pt) for 2013, rising to $20,117 ($2,874 per average pt) for 2015 vs the baseline. Conclusions: Adding nab-paclitaxel plus gemcitabine as a treatment option for first-line metastatic pancreatic cancer pts was estimated to increase costs by 12% (about $2000 per average pt per year) over a three year period. The principal cost drivers were replacement of generic gemcitabine monotherapy, partially offset by savings from replacing FOLFIRINOX. [Table: see text]