bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using QOPI metrics for physician incentive compensation.
Authors: Makari-Judson Grace , Wrenn Tamara , Mertens Wilson C. , Josephson Gordon , Stewart James A. 
Published: February 2017

241 Background: Physician incentive or variable compensation (VC) models are typically based on work relative value units (wRVU). Baystate Medical Practices (BMP), a group of over 450 practitioners, is evaluating a division based pilot program for VC that, while it includes wRVUs, also includes other important performance metrics. QOPI is emerging nationally as a comprehensive method for assessing quality across oncology practices. We describe the use of QOPI measures as part of a financial incentive plan for a hospital-based oncology division. Methods: A nine member QOPI certified Oncology Division participated in a pilot VC plan with group specific targets selected based on prior below average performance. 20 overall weighting percent (10% weight per category) of the overall VC framework was linked to success in two QOPI categories; “completion of treatment summaries (RxS) within 90 days of end of chemo” and “assessment of patients’ emotional well being by second office visit.” Three tiers of achievement were set for each goal. For RxS completion, Tiers I, II and III were defined as completion of 15, 25, and 40% of charts respectively as measured by an internal audit. For assessment of patient emotional well being tiers were at the 75th, 80th, and 85th percentiles of national QOPI participants. A formula combining VC goals into year-end VC payout was driven by three levels of percent base salary: 8, 12, and 24% respectively. The probability of achievement of each goal was expected to be 90, 50, and 10% respectively. Educational discussions with BMP leadership were held to teach about QOPI validity in the oncology community. Results: BMP fiscal year ends September 30, thus final numbers are pending. With systems based improvements, Tier I achievement for emotional well being and Tier II achievement for RxS completion is expected. The division is interested in using different QOPI measures for VC next year with the goal of continuous improvement in QOPI scores. Conclusions: QOPI metrics can be used as a quality incentive for oncologists in the setting of a VC plan. Non-oncologists can appreciate the strength of QOPI as a quality tool. With time, the combination of a QOPI program through ASCO and use of various QOPI metrics can drive continuous improvement in an oncology group.
Access to palliative care before death among patients treated at a comprehensive cancer center.
Authors: Hui David , Kim Sun Hyun , Kwon Jung Hye , Tanco Kimberson Cochien , Zhang Tao , Kang Jung Hun , Rhondali Wadih , Chisholm Gary B. , Bruera Eduardo 
Published: February 2017

25 Background: Palliative care (PC) access is a critical component of quality cancer care. Previous studies on PC access have mostly examined the timing of PC referral. The proportion of patients who actually received PC is unclear. We determined the proportion of cancer patients who received PC at our comprehensive cancer center, and the predictors of PC referral. Methods: We reviewed the charts ofconsecutive patients with advanced cancer from the Houston region seen at MD Anderson Cancer Center and died between September 2009 and February 2010. We compared patients who received PC services with those who did not receive PC services before death using univariate and multivariate logistic regression. Results: A total of 366/816 (45%) decedents had a PC consultation. The median interval between PC consultation and death was 1.4 months (interquartile range (0.5-4.2) and the median number of medical team encounters before PC was 20 (6-45). In multivariate analysis, older age, being married, and specific cancer types (gynecology, lung and head and neck) were significantly associated with a PC referral (Table). Patients with hematologic malignancies had significantly fewer PC referrals (33%), the longest interval between advanced cancer diagnosis and PC consultation (median 16 months), the shortest interval between PC consultation and death (median 0.4 month), and one of the largest number of medical team encounters (median 38) before PC. Conclusions: We found that a majority of cancer patients at our cancer center did not access PC before they die. PC referral occurs late in the disease process with many missed opportunities for referral. Further effort is needed to improve quality of end-of-life care. [Table: see text]
Using a pathways process to ensure measurable evidence-based standardized care in a large cancer network.
Authors: Ellis Peter G. , Lokay Kathleen 
Published: February 2017

252 Background: UPMC CancerCenter includes 40 sites of services in a 100 mile radius in Western Pennsylvania. Consistency and quality of care are critical to such a diverse network. In addition, the UPMC mission includes accrual to clinical trials. To meet these challenges, UPMC developed the Via Oncology Pathways. The program has served UPMC well for over seven years to date and is now a key foundation for UPMC’s overall healthcare reform strategy for quality and accountable care. Methods: Treatment algorithms were developed for 90% of cancer types by establishing committees of academic and community specialists. These committees interpret the literature and define the most efficacious, least toxic, and economically efficient treatment regimens appropriate for highly specific disease presentations (e.g., node +, er-, her2 +, PS 0-1). Clinical trials are also imbedded into the algorithms. Quarterly, these algorithms are reviewed by the committees to assess relevance, review network feedback, add newly available trials and address emerging data. Equally important to clinical content is its presentation to the practicing physician in a manner that allows real time usage and adds value to physician workflow. This is accomplished with a web portal that presents the individual pathways status through the physician’s daily schedule. Results: Over 120 oncologists at UPMC use Via Oncology Pathways in their daily practice. In 2011, UPMC physicians confirmed a pathways status for 94% of their patient visits (195,000) and achieved an On Pathway rate of 82% for their 18,000 treatment decisions. The database also includes patient presentations, reasons for going off pathway and reasons for not accruing to clinical trial. Lower hospitalization rates and mandated adoption of personalized medicine were also observed. Conclusions: When appropriately developed and implemented, clinical pathways are a solution to improving the quality and cost effectiveness of cancer care by enhancing physician decision-making, standardizing care and ensuring access to evidence-based personalized medicine. We continue to expand the scope of our pathways to include diagnostic studies, surveillance protocols and end of life prompts.
Identification, categorization, and mapping of indicators used by JACIE-accredited stem cell transplantation programs to assess distribution and coverage of processes.
Authors: Olivia Caunday , Odette Agulles , Eoin McGrath , Fabienne Empereur , Jean Francois Stoltz , Christian Chabannon 
Published: February 2017

255 Background: More than 145 European hematopoietic stem cell transplantation (HSCT) programs received JACIE accreditation since 2000, demonstrating compliance with FACT-JACIE international standards. The association of JACIE with improved patient outcome was recently documented. Conditions in which quality management systems were introduced and actual benefits remain to be fully evaluated. Methods: The study explores one aspect of quality management: introduction and use of indicators. Through a questionnaire sent to JACIE accredited centers, we aimed at identifying indicators (name, domain of application, category, longevity, and general description), understanding how they were set in place, whether or not similar indicators were used by different programs, and whether all of the HSCT processes were monitored. The survey was first sent to 14 French accredited HSCT centers and next to 68 other programs in 11 European countries. Categorization was double-checked against published criteria. Results: The response rate was 40% (32 programs). 293 indicators were collected, including 224 (76%) that were introduced during the preparatory phase of JACIE accreditation. Indicators were associated with the following processes measurement, analysis and improvement (54/293 or 18%); donor collection (49/293 or 16%); processing and storage of cell therapy products (37 /293 or 12.5%), administration of HPC (67/293 or 23%). Mapping reveals an uneven distribution of indicators across the different sub-processes that contribute to this highly-specialized medical procedure. Moreover, we found that only 101/293 indicators (34%) comply with the rules for implementation of a quality indicator, as defined by the FDX 50-171 standard. Conclusions: This suggests that risks to donors/recipients are unevenly monitored, leaving critical medical steps with low levels of monitoring.
Patterns and predictors of chemotherapy and trastuzumab use for early-stage breast cancer in Kaiser Permanente Northern California, 2004-2007.
Authors: Kurian Allison W. , Lichtensztajn Daphne , Keegan Theresa H.M. , Leung Rita W. , Shema Sarah J. , Hershman Dawn L. , Kushi Lawrence H. , Habel Laurel A. , Kolevska Tatjana , Caan Bette Jane , Gomez Scarlett Lin 
Published: February 2017

256 Background: Chemotherapy regimens for early-stage breast cancer have been extensively tested by randomized clinical trials, and specified by evidence based-practice guidelines. However, little is known about the translation of trial results and guidelines to oncology practice. Methods: We extracted individual-level data on chemotherapy administration from the electronic medical records of Kaiser Permanente Northern California (KPNC), a pre-paid integrated health-care delivery system serving 29% of the local population. We linked data to the California Cancer Registry, incorporating demographic and tumor factors, and performed multivariable logistic regression analyses on the receipt of specific chemotherapy regimens. Results: We identified 6,178 women diagnosed with stage I to III breast cancer at KPNC during 2004 to 2007; 2,735 (44.3%) received at least one chemotherapy infusion at KPNC within 18 months of diagnosis. Factors associated with receiving chemotherapy, and specifically receiving anthracyclines, taxanes, and/or trastuzumab, included young age, large tumor size, involved lymph nodes, hormone receptor-negative or HER2/neu-positive tumors, and high tumor grade; comorbid conditions were inversely associated with chemotherapy use (heart disease for anthracyclines, neuropathy for taxanes). We observed less chemotherapy use by unmarried women, less anthracycline and taxane use by low-socioeconomic status (SES) non-Hispanic whites, and more anthracycline use by high-SES Asian/Pacific Islanders (versus high-SES non-Hispanic whites). Concordance with relevant measures of the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) was highest among younger women with larger, higher grade tumors. Conclusions: In this health care organization with essentially equal access, we discovered that chemotherapy use was concordant with practice guidelines, yet may vary according to socio-demographic factors. These findings may inform efforts to optimize treatment, and guide studies of quality in breast cancer care.
From evidence to impact: Determining the vital few indicators for systemic treatment computerized prescriber order entry systems (ST CPOE).
Authors: Lankshear Sara , Theriault Marc , Cheung Annie , Hertz Sherrie , Kaiser Leonard , Kukreti Vishal 
Published: February 2017

258 Background: It is important to demonstrate that delivery systems contribute to patient outcomes. Quality indicators provide a quantitative, evidence based (EB) foundation for clinicians, organizations, researchers, and administrators to monitor and evaluate performance of these systems. Technologies, such as ST CPOE systems are costly, impact clinician practice and therefore, would benefit from accountability through quality measures. The process for the identification of EB indicators for measuring the impacts of ST CPOE systems is described. Methods: The indicators were developed alongside the ST CPOE Best Practice Guideline. A multi-phased approach included the development of a conceptual framework, defining quality dimensions, literature review, environmental scans, and key informant interviews. An initial list of indicators was identified and aligned with the relevant quality dimensions (i.e. safety, effectiveness, efficiency, integration). A Modified Delphi methodology, involving internal and external content experts in oncology practice, technology, informatics, and human factors, was undertaken to obtain consensus on the vital few. Results: Three rounds of Modified Delphi exercises were conducted with the initial list of 118 indicators. 15 clinical practice indicators (CPI) were deemed as relevant for overall evaluation and research purposes specific to ST CPOE systems. Within this group, four indicators were identified as being valuable for reporting quality monitoring at the organizational, regional and provincial levels. In addition to CPI, 74 system functionality (e.g. usability, alert features, system integration) indicators were identified. Conclusions: Through engagement of experts and evidence review, we have identified a set of quality indicators for ST CPOE systems which will facilitate appropriate evaluation of systems and implementation processes. Operationalizing these indicators for automatic data flow through is planned in a large geographic area.
Compliance to select quality measures in a non-QOPI subspecialty academic practice: A pilot quality improvement initiative.
Authors: Reichert Sonia , DeGregorio Paola , Bilotti Lauren , Ulysse Fabienne , Sung Max , Holcombe Randall F. 
Published: February 2017

261 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) includes core, disease and domain-specific quality measures. QOPI Certification requires an overall score of 72.62% in 24 core and 80% in adjuvant quality measures. There are currently 137 oncology practices with only 10 in New York State having achieved QOPI certification. At Mount Sinai Medical Center (MSMC), the large hematology and oncology practice is subdivided into disease-specific groups functioning semi-autonomously. The practice is not QOPI certified. With no prior measures of quality adherence in the overall or subspecialty groups we aimed to determine the baseline compliance to QOPI disease specific measures. Methods: All colorectal patient charts seen in the GI oncology group at MSMC over a four-month period from February 2012 to May 2012 were retrospectively reviewed. The team included two GI oncology physicians, one physician assistant and one registered nurse. Each member was assigned roles to meet the defined quality measures prior to project initiation. A separate auditor reviewed medical records during the study period. 17 quality measures were evaluated including 10 core and one adjuvant colorectal disease-specific measure. Results: The average compliance with the QOPI measures tested was 96%, 98%, 92%, and 97% (February to May respectively). The measures with the lowest compliance were not required for certification but included for internal review after recent practice changes. Despite the high compliance rate, compliance for an individual patient in all 17 categories was achieved in only 48% of patients. Conclusions: This study highlights that adherence to quality benchmarks in a disease-specific subset of a larger oncology program can be achieved by identifying staff, assigning roles and defining practice structure. The GI Oncology group attained a level of compliance with quality measures that would result in QOPI certification if maintained practice-wide. This study serves as the basis for a larger internal audit of quality measures across other subspecialty disease-specific areas of hematology and oncology at MSMC.
Method of biopsy and sample quality for genetic mutation testing in advanced non-small cell lung cancer in a community hospital.
Authors: Hrinczenko Borys , Subramonia-Iyer Subramony 
Published: February 2017

271 Background: Mutated EGFR gene testing transformed the care of NSCLC. ASCO now recommends EGFR mutation testing for NSCLC (April 2011); however, no studies to assess quality of biopsy samples and adequacy for mutation testing have been done outside a trial setting. Methods: A retrospective chart review to identify patients diagnosed with NSCLC at a community hospital during 2010. A pathologist reviewed the quality of archivedbiopsy samples for histological diagnosis and adequacy for EGFR mutation testing based on ASCO criteria. Results: In 2010, 64 cases of NSCLC were diagnosed and 18 patients had definitive surgery, 46 did not. Histological subtypes: squamous - 28 (44%), adenocarcinoma - 23 (36%), bronchoalveolar - 3 (5%), adeno with mixed bronchoalveolar - 2 (3%), large cell - 3 (5%), and large cell neuroendocrine - 2 (3%). Staging: stage I, II, III, IV - 18 (28%), 2 (3%), 13 (20%), 23 (36%). Biopsy material: transbronchial needle biopsy in 23 (36%), CT-guided biopsy in 13 (20%), surgery in 18 (28%), other - 10 (15%). Specimen review: 3 samples (5%) were designated as large cell carcinoma without squamous or adeno specification. 46/64 (72%) were adequate for mutation analysis; 18 (28%) were not. Among adenoca., 19/28 (68%) were adequate samples, but 9 (32%) were not. Among the 46 patients who had advanced or metastatic disease, 28 (60%) had sufficient samples, 18 (40%) did not. Among advanced adenoca. patients, the proportion without adequate sample was 9/18 (50%). Route of biopsy: 4/23 transbronchial biopsies (17%), 8/13 CT-guided biopsies (62%) and 6/10 from other sites (60%) were inadequate (p = 0.01). Conclusions: Nearly one-third of all NSCLC cases, including half of advanced adenoca., yielded poor quality specimens from the first biopsy for EGFR mutation analysis. 5% of samples lacked definitive histology. CT-guided transthoracic biopsies were at least twice as likely to yield poorer quality specimens compared to transbronchial biopsies. Poor quality tumor sampling may preclude mutation testing thus denying beneficial and less toxic therapy. Quality of tumor specimens needs to be improved in the future by the development of appropriate strategies by multidisciplinary lung cancer teams.
Coordination and timeliness of care by insurance status in a gastrointestinal (GI) multidisciplinary care (MDC) program.
Authors: McCahill Laurence E. , Kokko Jamie , Davis Alan T. , Taylor Wendy K. , Martinez Coralyn , May Mary 
Published: February 2017

272 Background: Patients with newly diagnosed GI cancers require diagnostic studies and evaluations by physicians that may delay initiation of cancer care. Uninsured populations are particularly vulnerable. A Nurse Navigator (NN) can help decrease barriers and improve timeliness of care. This study aims to compare timeliness of cancer care received by patients referred to a GI MDC Program by the patient’s insurance status at the time of referral. Methods: Patients referred to the GI MDC are assigned a NN who evaluates medical history, diagnostic studies, and coordinates further testing and physician evaluations. Timeliness measures assessing milestones in cancer care initiation are collected prospectively. Descriptive statistics are presented and average times for measures are compared by insurance status (insured vs. uninsured) using t-tests, chi-square tests, and the Fisher’s Exact test. Results: 366 patients were evaluated between January 2010 and June 2012. 70% (255/366) were for new cancer diagnoses. Median age of cancer patients was 64 years (range 29-94), 63.1% of patients were male, and 94.1% of patients had insurance. Major cancer diagnosis types were colon/rectal (19.2%), esophageal/gastric (25.1%), hepatobiliary (12.8%) and pancreatic/ampullary/duodenal (35.7%) and 1.6% other. The table describes timeliness and care coordination measures by insurance status. Conclusions: Uninsured cancer patients in our health system appear to receive care in a timely fashion which does not differ from patients with insurance. The impact of a dedicated GI NN in avoiding disparate care for uninsured warrants further study. [Table: see text]
Average breast cancer stage in patients with various insurances and incomes.
Authors: Haroon Sehr 
Published: February 2017

278 Background: Worsening global economy is increasing uninsured vs. other insurance (private, medicare, Medicaid, VA). Average stage of breast cancer is likely higher in uninsured vs. other insurance. Methods: Individuals diagnosed with breast cancer (diagnosed 2000- 2009) were reported to the National Cancer Database (NCDB). Variables of insurance status (uninsured, private, Medicaid, Medicare, and VA), stage of diagnosis (0:carcinoma in situ- 4:metastatic disease), and income level (<$28k, $28k-32,999, $33k-38,999, $39k-48,999, $49k+) were analyzed. Results: From 2000-2009, the privately insured percentage decreased by 39.4%, with 134.3% increase in Medicaid insured. Average stage in uninsured was 1.8, statistically significant compared to 1.2 for privately insured, and 1.5 for Medicare. This was untrue of VA and Medicaid insured. Significant differences exist between uninsured and Privately insured for every income. At $28K/yr, average stage of breast cancer was 1.9 in uninsured,1.5 in privately insured. When income >49K/yr, average stage was 1.7 in uninsured, 1.3 in privately insured, while VA insured remained 1.4. Conclusions: Uninsured patients had worse stage than privately insured. For private and Medicare insured, increasing income correlated significantly to earlier stage of diagnosis4, which was untrue for uninsured, VA, and Medicaid insured. Highest stage was in lowest income uninsured, whereas lowest stage was in highest income, privately insured. Income did not effect average stage of VA. [Table: see text]