bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of electronic records in reporting adverse drug reactions.
Authors: Poirier Alanna M. , Nachowicz Paul , Misra Subhasis 
Published: February 2017

309 Background: The Pharmacy and Therapeutics committee at a regional cancer center is responsible to report and trend existing adverse drug reactions. The electronic health record did not have an option to document the history of an event or have an alert function if a medication was re-ordered. The frequency of documented adverse drug reactions did not correlate to what was being observed on the units with the use of a paper document. Methods: InAugust 2010 a Lean Six Sigma project was initiated to improve adverse drug reaction reporting. An adverse drug reaction document along with standard work instructions was completed by March 2011. A report was built in the electronic health record and a computer based learning module was created and rolled out to clinical staff by October 2011. Results: The turn-around time in days to document an adverse drug reaction in the patients chart decreased from 6.8 days to 0.7 days. The documented adverse drug reactions increased by 37%; verified by the use of supportive medications. Conclusions: The root cause for under-reporting was attributed to lack of knowledge, process, and automation. The history of an adverse drug reaction can now be viewed and an automatic alert is produced requiring physician acknowledgement decreasing the chance of repeated discomfort or harm to the patient. Adverse drug reaction documentation can be retrieved within 24 hours, analyzed, trended, and used for educational purposes to improve patient safety. [Table: see text]
Racial differences in health care utilization in Medicare beneficiaries with metastatic prostate cancer.
Authors: Bailey Robert A. , Shih Huai-Che , Schneller Francesca , McKenzie R. Scott , Feldman Rachel 
Published: February 2017

31 Background: Racial differences in the prostate cancer (PC) incidence and outcomes have been previously reported. Patterns of PC care have been studied previously in commercially insured populations. This study evaluated racial differences in health care (HC) utilization in Medicare Beneficiaries with metastatic prostate cancer (MBMPC). Methods: MBMPCs were identified using Medicare 5% Standard Analytic Files (2002-2009) which included the Medicare fee-for-service population covered by Part A and Part B. HC costs were standardized to 2010 dollars. Patterns of care were analyzed and compared by race [White (W), Black (B), Other (O)]. Results: We identified 5,857 MBMPCs (W: 2,998, B: 748, O: 164) with a mean (SD) age 79.3 (9.4) years. Minimal differences in care were present between W and O. Compared to W, B received less outpatient care. Mean physician office visits/year: 21% fewer for all specialties (B: 10.4, W: 12.6, p<0.001), 20% fewer for primary care (B: 3.5, W: 4.2, p<0.001), 27% fewer for oncology (B: 2.2, W: 2.8, p<0.001), and no difference in urology (B: 1.9, W: 1.9, p=0.638). There was a 50% higher number of mean hospitalizations/yr in the B group (B: 1.2, W: 0.8, p<0.001). There was no difference in surgical intervention by race, however B were generally less likely to receive injection hormone therapy (HT), radiation therapy (RT), or chemotherapy (CT) prior to, concomitant to, or subsequent to the first metastatic diagnosis. Mean annual HC costs were 23% higher for B (B: $29,141, W: $23,735, p<0.001), with institutional care comprising 62% of total costs for B and 52% for W. Conclusions: In MBMPC, significant differences in HC between B and W were observed. B were less likely to experience physician office visits and to receive HT, RT, or CT, and more likely to be hospitalized. Further study is warranted to identify contributing factors and potential ways to reduce these observed HC disparities including patient education and patient engagement in decision-making.
Medical informatics: Documenting quality of end-of-life oncologic care.
Authors: Obel Jennifer Carrie , Orlando-Brooks Diletta , Konchak Chad , Harper Abigail , Marschke Michael , Kharasch Maureen , Brockstein Bruce , Raymond Michael , Robicsek Ari 
Published: February 2017

311 Background: NorthShore University HealthSystem has created, via the Electronic Health Record (EHR), quarterly reports to measure quality of care for patients who die of cancer during the reporting time frame. Specific reports for 22 oncology providers and measurements across the population will be derived. Reports are automated with seamless data retrieval based on algorithms designed through the use of discrete, searchable entry fields. Goals include establishing a pre-report baseline, educating oncologists about their terminally ill patients’ outcomes and documenting improvements in end-of-life care through educational initiatives for patients and providers. Methods: To standardize reporting, a cohort of terminally ill patients was created based on QOPI definitions (Denominator). A set of quality end points to describe cancer utilization near the end of life was added as Numerator Values, to establish rates of potential inappropriate use of resources. Results: The OP, oncology EHR was changed to allow ADN/CSO placement that carry over to the IP EHR (hyperlink in patient header). The average time between a patient’s first OP, oncology visit and when the oncologist placed ADN/CSO will be calculated. ADN/CSO reports will be stratified by a patient’s age, race and oncologist. Each separate report will be validated prior to the “go live” phase. Conclusions: These metrics allow routine hypothesis generating queries of end-of-life care to assess compliance with quality measures. [Table: see text]
The “Big 6 Spotlight”: Baseline assessment and implementation of a process to systematically collect critical oncology data elements for quality improvement and research.
Authors: Li Edward C. , D’Amato Steven L. , Barr Thomas R. , Weisberg Tracey 
Published: February 2017

312 Background: An Institute of Medicine (IOM) report recommends using electronic health record data for quality improvement and research. To do so, a critical density of data elements must exist. Oncology Metrics, a division of Altos Solutions, Inc. identified 6 data elements (“The Big 6”) of high priority for obtaining data density: 1) staging; 2) intent of therapy; 3) adverse event grade; 4) disease status; 5) patient status; 6) line of therapy. Process improvement measures are being implemented to improve the prospective, systematic reporting of the Big 6 by practices using OncoEMR. An analysis of data element completion frequency is necessary to provide feedback to clinicians in support of a process improvement strategy. Practices also require benchmark information to compare their performance with expectations and the aggregate. Methods: Altos developed the Big 6 Spotlight as a toolbar selection in OncoEMR for physicians to monitor and enter patient Big 6 data elements concurrently with the provision of patient care. Baseline data for 7/2012 was collected for each physician in the practice before they were educated and trained on the data entry program. We report baseline and post implementation information about the density of the Big 6 at one private practice utilizing OncoEMR. Data are also compared to historical and national benchmark data. Results: The percentage of patients/events with staging, intent of therapy, adverse event grade, disease status, patient status, and line of therapy completed was calculated by dividing the number of fields complete by the total number of patients/events. These were: 68%, 6%, 0.3%, 4%, 61%, and 22%, respectively. Post implementation data are not available at the time of this writing. Conclusions: Big 6 data density will be assessed post-implementation of the Big 6 Spotlight initiative to monitor improvement. Data uniformity and consistency will be also be evaluated. Ensuring that this dataset is of high internal validity allows for the conduct of quality improvement and research studies, moving us closer towards achieving a rapid-learning system as described in the IOM report.
Patient identification and tracking for chemotherapy delivery: Use of RFID or barcode technologies for automated self check-in.
Authors: Cheung Matthew C. , Trudeau Maureen E. , De Mendonca Ben , Beattie Kathy , Sousa Philomena , Singh Simron 
Published: February 2017

316 Background: The Odette Cancer Centre (OCC) is the sixth largest cancer institution in North America and manages over 24,000 chemotherapy patient visits/year. We initiated an automated kiosk system whereby patients can “actively” self-check-in to the chemotherapy unit as part of a quality initiative to improve one of the most complex processes in patient care. Methods: From January-May 2012, consecutive patients receiving >2 cycles of chemotherapy were randomly assigned to either radio-frequency identification (RFID) or barcode technologies to facilitate self check-in and time-in-motion studies. In parallel, the former manual check-in system (with OCC staff) continued. The primary outcome was the proportion of patients with more 3 or more scheduled appointments who used the self-check system at least 2 times. Patient satisfaction was attained with baseline and post-study surveys. Results: The study accrued 81 patients (43 patients using RFID and 38 patients using barcodes). Mean age was 59 (20-81 years). Of 48 patients who completed baseline surveys, most had regular access to a computer (87.5%) and used the internet at least >1 hour/day (50%). However, 21% at baseline felt a person-to-person check-in was preferable to an automated option. With implementation of the study, 24 of 81 patients (29%) have used the kiosk only once. Of individuals with multiple scheduled appointments (at least 3), 50% assigned to the RFID group and 52.6% assigned to the barcode group used the kiosk at least 2 times (p=0.827; Fisher’s exact). In follow-up, 96.7% of patients agreed or strongly agreed that the kiosks were easy to use although only one-third (33.3%) of patients felt the new system improved the efficiency of care. Conclusions: An automated check-in process is feasible for a diverse population of patients receiving chemotherapy. Multiple uses of the kiosk technology suggest appropriate uptake and retention of the technology. Continued use of the system was not different between RFID and barcode technologies. Patient satisfaction was high despite the lack of improvement in efficiency. The next phase will incorporate patient tracking and real-time status updates to address these concerns.
A shared decision support system for localized prostate cancer.
Authors: Dadlani Pavan , Zhang Jingyu , Dries Sebastian P. M. , Ennett Colleen M. , Toet Esther 
Published: February 2017

326 Background: In the US, about 1 in 6 men is diagnosed with prostate cancer (PCa). Over 90% of them are localized PCa patients, which have the most controversial treatment decisions with few certainties about outcomes such as survival years and quality of life (QoL). Shared decision making is emerging, where patients need to make trade-offs between longevity and QoL based on personal preferences and treatment outcomes. Methods: By collaborating with leading PCa centers, medical psychologists and health economists, we investigate, iteratively design, and eventually test a decision support solution that could enhance treatment decision making and patient-clinician interaction. We interviewed 7 PCa clinicians and 13 patients and survivors, and observed 4 patient-clinician consultations. Results: Key insights from the user research: 1) existing decision aids are very generic and not personalized to the patient’s preferences, are not integrated in the clinical workflow, and involve a complex user experience; 2) there is a significant amount of unwarranted variation in PCa treatment (i.e. not preference sensitive, or patients lack the confidence to choose non-aggressive options that could lead to similar or better outcomes, e.g., active surveillance; and 3) clinicians need to understand what the patient’s preferences are (verbally discussed only), which consumes significant time in consultations. These insights led to developing a shared decision support system based on algorithms that use quantitative computations of quality adjusted life years (QALYs) and patient-friendly interactions. This system can be integrated in the clinical workflow, allow patients to make better informed decisions, and increase their confidence to choose the best treatment option according to their own preferences. We aim to increase patients’ involvement and satisfaction, enhancing consultation efficiency, and reducing unwarranted variation. Conclusions: Our ongoing research, motivated by user insights, focuses on developing shared decision support technology that is personalized to the patient’s profile and sensitive to their preferences. We will deploy validation studies at clinical sites and evaluate the system across the predefined outcome measures.
Investigating pocket cards to improve cancer patient knowledge of chemotherapy.
Authors: Curtis Kelly Kevelin , Johnson Carla M. , Northfelt Donald W. 
Published: February 2017

35 Background: Studies suggest cancer patients frequently misunderstand information about cancer treatment. Doctors and nurses often give cancer patients written information such as internet-downloaded printouts about chemotherapy. We observed that cancer patients at Mayo Clinic often cannot recall cancer drug names and expected side effects, despite receiving written information. We investigated whether pocket cards [PC] could improve drug name and side effect recall compared to written information alone. Methods: We randomized 100 cancer patients starting chemotherapy to receive PC plus written information or written information alone. Each PC listed the drug name and 3-5 common drug side effects. Written information included a Mayo Clinic produced drug information sheet and printed information from the CareNotes System (Thomson Reuters), with each sheet listing a drug’s name and common side effects. Cancer patients were tested for drug names and side effects recalled at treatment start, again at 4-6 weeks, and again at 8-10 weeks. Results: Of 100 cancer patients randomized (50 to PC plus written information and 50 to written information alone), 66 completed the study. Demographics: median age 64 years (24-81 years); 41 male; 59 female. At 8-10 weeks, no significant difference between groups was observed for drug names recalled correctly (p = 0.79) or median side effects recalled (p = 0.34). Drug name recall declined at 8-10 weeks (29% named drug names correctly at treatment start versus 20% at 8-10 weeks). Median side effects recalled was unchanged at 8-10 weeks (p = 0.19). Conclusions: PC do not appear to improve cancer patients’ drug name recall better that written information alone, nor do PC increase recall of drug side effects. Patient recall of drug names decreases over time. Additional education provided several weeks after chemotherapy has begun may be warranted to reinforce patient knowledge of important treatment-related information.
Barriers to patient accrual in Ontario oncology clinical trials: Attitudes of oncologists and clinical research personnel.
Authors: Bookwala Ammar , Dastur Daisy , Wong Audrey , Marchand Christina , Ebrahim Jalal , Hogeveen Sophie , Ansari Ata , Sevick Laura , Brezden Christine B. 
Published: February 2017

36 Background: The medical specialty of oncology relies heavily on clinical trials to advance policies and practices related to cancer care. However, oncology clinical trial accrual in Ontario has dropped from 12.4% in 2007, to 8.5% in 2009. The objective of this study was to determine barriers experienced by Oncologists and Clinical Research Personnel (CRP) in recruiting patients to oncology trials in Ontario. Methods: In June 2012, an electronic survey was emailed to about 400 oncologists and CRP across Ontario. Variables of interest included demographic data, clinical trial involvement, and perceived barriers to participation in clinical trials amongst three previously identified barrier domains. Barriers were ranked, from 1 (least significant) to 5 (most significant). Statistics were compiled using Graphpad Prism software. Differences in responses were analyzed using the Kruskal – Wallis test and Dunn’s Multiple Comparison Test. Results: Of the 400 emails sent, there were 126 respondents (32%). Of the 126 respondents, 82 fully completed the survey (64.6% useable response rate). Amongst system related barriers, “time related” (Median Agreement (M): 4, Inter Quartile Range (IQR): 3-5), and “resource related” barriers (M: 4, IQR: 3-5) had the most negative effect on accrual (p<0.05). Amongst trial design barriers, “Relevance to patient population” (M: 3, IQR: 3-5), “Deviation from Standard of Care” (M: 3, IQR: 3-5) and “Complexity of Trial Protocol” (M: 4, IQR: 3-5) were the most significant barriers (p<0.05). Lastly, amongst personal barriers, “Commitment of the Principal Investigator/Research Staff” (M: 4, IQR: 3-5) and Drug Safety (M: 4, IQR: 2-4) were the most significant barriers to recruitment (p<0.05). Conclusions: Multiple barriers were identified as having a significant impact on patient accrual in clinical trials. Addressing these barriers prospectively in clinical trial design may benefit future studies to successfully accrue cancer patients. Also, creating clinical trial collaboration vehicles amongst sites in similar geographical areas may contribute to improving patient accrual to clinical trials.
Early clinical adoption of next-generation sequencing panels for diagnosis of hereditary cancer susceptibility: A single commercial laboratory experience.
Authors: Barth Neil M. , Stuenkel Aaron , Chao Elizabeth 
Published: February 2017

37 Background: Genetic risk assessment and testing for patients suspected of inherited cancer susceptibility has become a standard of care in oncology services. Advances in molecular sequencing technology have facilitated the development of multi-gene hereditary cancer testing panels utilizing next-generation sequencing (NGS) methods. Appropriate utilization of these NGS panels by practitioners has been raised as a potential issue. In addition, patient stratification, safety and value-based resource allocation have been cited as possible areas of concern. In 2010, ASCO published updated guidelines for clinical utilization of genetic testing that included ordering based on appropriate risk stratification, informed patient consent, ordering by knowledgeable professionals, testing by a licensed laboratory, and results interpretation supported by counseling with qualified professionals. Methods: 467 patient samples submitted to a single commercial genetics laboratory for hereditary cancer testing by NGS panels were analyzed for compliance with guidelines based on information supplied with samples. Results: All samples were accompanied by an informed consent as part of the requisition. All samples originated from a licensed medical facility and all except one came from the domestic United States. Only 13.1% of providers ordering cancer predisposition testing utilized the NGS panels while 25.1% of organizations ordering cancer predisposition testing utilized the NGS panels. Genetic counselors were involved in 71.5% of the NGS panel orders, medical oncologists were involved with 32.5% of orders, and 24.8% of tests were ordered from practitioners of unknown clinical specialty. Samples from non-Caucasian minorities were under-represented based on national census demographics. Of the NGS samples from breast cancer patients, 90% were reportedly BRCA1/2-negative and median age at diagnosis was 42 years old. Conclusions: Early analysis of the clinical samples received by a single commercial laboratory for NGS hereditary cancer screening demonstrated conservative utilization with general adherence to recommended clinical adoption criteria.
A multicenter, phase IV study of the effectiveness of palliative gemcitabine in patients with advanced pancreatic cancer.
Authors: Wallace David , Zhang-Salomons Jina , Booth Christopher M. , Mackillop William J. 
Published: February 2017

46 Background: Randomized controlled trials (RCTs) have shown that palliative gemcitabine provides clinical benefit and prolongs survival in patients with advanced pancreatic cancer. The purpose of this study was to determine if the efficacy of palliative gemcitabine demonstrated in RCTs has translated into effectiveness in routine clinical practice in Ontario. Methods: This was a retrospective cohort study of all patients with exocrine cancer of the pancreas treated with first line, single agent, palliative gemcitabine at all 13 provincial cancer centres in Ontario between 2008 and 2011. These patients were identified by linking electronic records of treatment from all cancer centres and hospitals in Ontario to the Ontario Cancer Registry. Patient-reported well-being and symptoms were captured by the Edmonton Symptom Assessment System, which has been in routine use at these centres since 2008. The effectiveness of gemcitabine was measured in terms of clinical benefit at two months and overall survival. Patients were classified as having achieved clinical benefit if they had not discontinued gemcitabine and their self-reported well-being was stable or improved at two months. Results: The study population included 423 patients. Their median age was 65 and 50% were women. Fifty-seven percent had stage IV disease, 17% had stage III disease, and 10% had recurrence after earlier treatment for stage I or II disease. Patients included in this study were older than, but otherwise similar to, patients enrolled in four relevant RCTs that used gemcitabine in the experimental or control arm. At two months, 36.9% (95% CI 29.6-44.2%) of patients in this study achieved clinical benefit, which was within the range of 24% to 56% observed in patients in these trials. Median overall survival was 5.7 months (95% CI 4.7-6.1), which was within the range of 5.4 to 6.9 months reported in the trials. Conclusions: The efficacy of gemcitabine demonstrated in RCTs has translated into effectiveness in routine clinical practice in Ontario. The approach described above could readily be used to study the effectiveness of other palliative interventions.