bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term outcomes of implementation of a computer-based breast cancer risk assessment program during screening mammography.
Authors: Ray Debra , Grumet Sherry , Lagmay-Fuentes Portia , Jacob Lolita , Terzo Annette , Puma Alex , Hwang Shirley 
Published: February 2017

298 Background: Major barriers to high risk breast cancer risk assessment include inadequate documentation of family history, complexity of risk calculation and model selection, and lack of awareness. We have established a high risk breast cancer assessment program using a computer-based real time risk calculation at time of screening mammography. Objectives were to facilitate identification of high risk patients needing genetic counseling/testing and MRI breast screening. Methods: Beginning 11/23/2010, prior to screening mammogram all patients completed a self reported risk assessment using a wireless tablet. With real time risk calculation for risk of genetic mutation (Myriad and BRCAPRO models) as well as life time risk of breast cancer (Gail, Claus, Tyrer-Cuzick, and BRCAPRO models) using HughesRiskApps patients were categorized into high risk ( ≥ 10% gene mutation risk or ≥ 20% life time breast cancer risk) or average risk groups and received a risk assessment letter. The risk data was integrated into mammography information system (Penrad) simultaneously. High risk patients were contacted by a coordinator to facilitate high risk clinic evaluation. Results: As of June 30, 2012, 24,213 patients without a cancer history completed HRA; 2,196 patients (9.1%) have been identified as high risk- for genetic mutation 1,051 pts, (4.3%), life time risk 1,570 pts, (6.5%), and both risks 425 pt, (1.8%). 416 patients (18.9%) of those high risk patients have been evaluated in the high risk clinic. 231 patients have been evaluated by genetic counselor and 97 have had genetic testing and 9 with positive results (9.3%). Yearly screening breast MRI has been recommended to 254 patients. Conclusions: We have successfully implemented breast cancer risk assessment through screening mammography service. Results suggest that 9.1% of our patients can benefit from high risk clinic assessment and 4.3% should have consideration for gene mutation testing. 6.5% of our patients may benefit from screening breast MRI. We strive to improve the number of patients who proceed with high risk clinic assessment by education of our patients regarding benefits of screening and risk reducing strategies.
Using computerized chemotherapy ordering to improve performance and documentation of informed consent.
Authors: Brandman James F. , Knop Carol , Giammicchio Karen 
Published: February 2017

299 Background: Informed consent is the foundation of patient-centered care. In the context of clinical trials involving chemotherapy, rigorous adherence to this principle is required. However, for the large majority of patients treated with chemotherapy outside of clinical trials, adherence to obtaining consent is suboptimal. In the past five Quality Oncology Practice Initiative (QOPI) audits, Northwestern University Hematology/Oncology performed worse than other academic cancer centers and the aggregated QOPI cohort. Methods: Informatics devised three steps to transform the process from memory dependent to electronically driven: 1. Insertion of “InformedConsentChemotherapy” generates text documentation of the required elements of informed consent: Cancer/Stage, Goals, Dose/Schedule, Side effects, Alternatives. 2. Required completion of the following pop-up attestation before electronic orders can be signed: “Informed consent (including the required elements) has been discussed and documented.” 3. Display of the completed attestation statement when the patient’s chemotherapy module is accessed. Results: One month after implementation an audit showed 100% display of the attestation statement and 98% concordance with actual informed consent documentation. Conclusions: This innovative informatics process change yielded major improvement in adherence to the fundamental patient-centered standard that chemotherapy informed consent be discussed and documented. Potential weaknesses in this informatics solution include completion of the attestation without documentation of informed consent and completion of the attestation without an actual consent discussion. The audit demonstrated that the first occurs rarely while the second is impossible to measure without continuous direct observation. Minimizing dependence on memory, the advantages of electronic chemotherapy ordering provide the capacity to make doing the right thing—documenting informed consent—the easy thing. [Table: see text]
Developing and implementing a balanced scorecard to improve efficiency, cost-effectiveness, and patient experience.
Authors: Colman Gerard , Moorad Julianna Grisham 
Published: February 2017

3 Background: MD Anderson Cancer Center’s Balanced Scorecard initially created in 2005 by the Office of the SVP and Chief of Operations reports key monthly financial, productivity, process and satisfaction metrics for 29 outpatient care centers on the main campus. It was developed as a management tool of standardized metrics to help align the centers’ annual operational goals with the institution’s overall strategy, goals, and processes, to improve operational efficiency, drive down costs and improve access and patient experience. Methods: The first step to develop the scorecard was to identify metrics that could be measured across all centers under each key strategic goal: financial, productivity, process, and satisfaction. The next step was to set target goals with a standard improvement percentage based on previous year’s performance. The result is a monthly overall trend score for each center. Lastly, a two-way communication process for reporting and recording the metrics was established. Results: The ultimate benefit of the scorecard is to positively impact patients and oncology care by not only delivering quality patient care, but doing it efficiently and cost effectively. The tool is transparent to all center directors and promotes accountability and sharing of best practices. Centers are actively engaged in the achievement of metrics by continuous monitoring and improving processes. The impact of improvement initiatives is easily identified via trends on the scorecard. Specific results include increased billed activity per FTE, reduced access time for new patients, increased exam room utilization and increased patient satisfaction. Within the past year, one center reduced access time for new patients by 50% from 15.59 days to 7.75 days, another center increased room turns by 5.7% from 4.01/hour to 4.25/hour. Conclusions: The value of the balanced scorecard comes from the transparent reporting and continuous owner pursuit of improvement within each of the four strategic areas. It aids in the challenge of balancing clinical care measured outcomes, patient access and throughput, and satisfaction with the business processes so that MD Anderson can continue to provide quality patient care.
Implementation of a visual appointment system to enhance oncology infusion suite efficiency at Norris Cotton Cancer Center (NCCC).
Authors: Schlosser Evelyn , Gladstone David , Scribner Deborah , Snide Jennifer 
Published: February 2017

301 Background: Infusion suite patients were experiencing excessive delays for administration of chemotherapy, blood products, and hydration. Manually collected data revealed that 80% of patients did not start their infusion appointments on time, though there was limited additional data available for further analyses. The scheduling system allowed for booking a "start time" for infusion therapy, but there was no connection between the appointment slots and the actual number of infusion stations, length of the infusions, and available nursing staff. There was an identified need for 1) a “visual” scheduling system that would aid in better matching available resources with patient demand and 2) real time collection of electronic timestamps to better understand patient flow and improve efficiency. Methods: An already existing and supported visual scheduling system was introduced to the infusion schedulers. This system works by assigning patients to available resources (chairs and nurses) and timeslots. The system was piloted for four months before fully implemented. An electronic interface was created between the existing scheduling system and the visual system, eliminating the need for dual entry. Nursing began using the system to record the actual arrival and discharge times for patients. Scheduling guidelines were updated and additional functionality within the system was employed. Results: Adherence to the arrival and discharge processes are tracked on a monthly basis and shared with the infusion suite leadership and nursing staff. As compliance with check-in/out processes increase, actual utilization of the infusion suite by oncology service and treatment regimen is being evaluated. These data are useful in the identifying opportunities to reduce treatment delays and improve efficiency. Conclusions: Maximizing efficiency and utilization of infusion suite services is a goal of NCCC. Access to detailed electronic data that facilitates understanding of the demand for services and capacity of the system is critical to achieving this goal. It is our belief that a more efficient infusion suite will result in less treatment delays for patients.
Documentation of code status at an outpatient academic cancer center: A marker of discussing end-of-life preferences.
Authors: Ranganathan Anjana , Reardon Deborah , Evans Tracey L. 
Published: February 2017

307 Background: Documentation of a patient’s code status preference is becoming an increasingly emphasized part of medical care. Hospitals are adopting protocols that encourage code status documentation at the time of admission; however, this requires patients to consider end of life care at a time of acute illness with a practitioner with whom they have little familiarity. We sought to assess the proportion of patients with a documented code status preference in the electronic medical records (EMR) of our outpatient oncology clinics. Methods: The EMR for all patients seen at the Abramson Cancer Center in the months of March, April, and May 2012 were reviewed for the presence of a documented code status and the specific code status designation. The query was limited to patients seen by a medical oncologist and to patients with at least five outpatient visits occurring during or prior to the month being studied. Demographic information regarding patient age, race, religion, medical comorbidities, and oncologic diagnosis including stage were also recorded. Results: A median of 2,071 patients who have had at least five prior visits were seen per month by staff medical oncologists. Of these patients, a median of 49 patients (2%) had a documented code status recorded in the EMR. Patients seen by the thoracic medical oncology group were more likely to have a documented code status (17% vs. <1%); however, these results were not statistically significant (p=0.3173), likely due to extremely small numbers of documentation. Given the low numbers of code status documentation, we were unable to detect an association with any other demographic factor. Conclusions: At our institution, only a small minority of patients with an oncologic diagnosis has documentation of code status in the readily available EMR. This initial analysis emphasizes the need for a larger effort targeted at increasing documentation of code status in the outpatient setting where patients have a longitudinal relationship with their care provider.
Combining web-based educational tools and mobile apps.
Authors: Kukreti Vishal , Sutcliffe Ken , Dosis Angela , Hertz Sherrie 
Published: February 2017

315 Background: Mobile apps (MA) can be useful resources to provide point of care information. Over 50% of patients use a smartphone (SP), 75% of North American physicians own a SP, and 58% of SP users have downloaded mobile MA. MA are more readily accessible than web-based tools and usable without network connectivity. Methods: Cancer Care Ontario (CCO) has developed MA for patients and providers using the principles of end user satisfaction, simplicity and intuitiveness. These MA are taken from established web based, validated educational modules. Designed to ensure a rich native experience for each platform (WP7 and iOS), CCO’s process includes proof of concept, information design, and user interface design supported by user acceptance testing. Results: Two MA have been created: “CCO Drug Formulary” and “CCO Symptom Management Guidelines Application”. The first MA provides information on both drugs and regimens used in cancer treatment for patients and providers through alternate navigation in the same MA. From launch in October 2011 until June 2012, the Drug Formulary app had 4,280 downloads, including 39% from Asia and 14% from Europe, suggesting a global market. The second app provides symptom management guidelines for providers, hence supporting clinical decision making at point of care. From January 2011 to June 2012, the Symptom Management Guidelines MA had 4,050 downloads, in a mainly North American market. Both patient and provider feedback on preliminary evaluation has been positive. Conclusions: Patients and providers are receptive to MA as a tool to deliver real-time information at point of care. MA are another interface to existing technology solutions and other rich data sources. Further research into patient outcomes from adoption of such technology is needed.
30-day mortality of surgeries in disseminated cancer patients: An analysis using NSQIP, dividing surgeries into low, medium, and high risk.
Authors: John Pesavento Anton , Silberstein Peter T. 
Published: February 2017

38 Background: This study is the first comprehensive analysis of surgical outcomes in disseminated cancer patients. Methods: ACS NSQIP has 30-day mortality data on 3,250 disseminated cancer patients and 144,199 patients who did not have disseminated cancer who underwent major surgery. Results: The most common procedures disseminated cancer patients had performed can be divided based on 30-day mortality into low risk (<3%), moderate risk (3-15%), and high risk (19-44%). Low risk surgeries include mastectomy, partial removal of the liver, and repair of the bowel opening (none of which were an emergency). Moderate risk includes non-emergent small intestine removal, bowel-to-bowel fusion, colon removal, and partial removal of the colon. High risk includes a non-emergent exploration of the abdomen, and the following surgeries if performed as an emergency: bowel-to-bowel fusion, colon removal, small intestine removal, cholecystectomy, or partial removal of the colon. Conclusions: The 30-day operative risk for disseminated cancer can be divided into low, medium, and high risk surgeries. All procedures performed under emergency circumstances have a 30-day mortality greater than 18%. Mastectomies, partial removals of the liver, and bowel opening repairs have a 30-day mortality of less than 3%. [Table: see text]
Patient (Pt) and caregiver (Cg) perspectives in non-small cell lung cancer (NSCLC).
Authors: Langer Corey J. , Evans Tracey L. , Belani Chandra Prakash , Middleton Gary William , Chouaid Christos , Pearson Kathleen , Ball Daniel E. , Bush Elizabeth N. , Guba Susan C. , Vansteenkiste Johan F. 
Published: February 2017

4 Background: Research investigating Pts’ preferences in treatment (tx) decisions for advanced (NSCLC) has generally been limited to smaller, single-country studies or anecdotal reports, and has rarely included Cgs’ perspectives. Methods: A 30 minute online or phone survey was conducted 28 June to 9 August, 2011. Survey participants (SP) included NSCLC Pts (n=245) or Cgs of NSCLC Pts (n=251) treated in the prior 12 months. A 1:1 non-paired sample of Pts and Cgs was sought in the US (n=295), France (FR; n= 100) and Germany (DE; n=101). FR and DE data were weighted to better reflect the age distribution of NSCLC in those countries, then combined. Results: For NSCLC SP, 64% were ≤65 years; 52% were male; 13% current smokers; 64% former smokers. Disease was localized in 21%, advanced in 73% and unknown in 6%. Tx was ongoing in 54%, and in 15% and 31% respectively tx was completed < 3 or 3-12 months previously. SPs elected tx to maintain independence (90%) and to control the cancer (89%); 81% were willing to continue tx indefinitely to maintain disease control. Although 69% of SP were greatly concerned about chemotherapy side effects, 60% were willing to endure significant side effects to live longer. SPs were comfortable asking their doctor questions (84%), and 68% were comfortable asking questions if they disagreed with recommended tx; 58% of SPs usually deferred tx decisions to the doctor. Comprehension of the tx plan was higher upon tx initiation (71%) than at diagnosis (46%) or at time of initial explanation by the doctor (62%). Many SPs (77%) relied on the nurses to help them understand their condition/tx. Among SPs in whom tx was discontinued (n=230), the most common reported reasons for stopping were that the cancer decreased in size (41%) or had stopped growing (28%). Only 14% believed tx was stopped because the cancer was not responsive, while 13% believed the cancer was gone. Conclusions: This large 3-country survey characterized factors important to the NSCLC SP in determining motivations for tx including a desire to control the disease and willingness to continue treatment for disease control if there was an acceptable risk/benefit balance. The survey also indicated a possible misapprehension on the reason(s) tx was halted.
Patient-reported oncology readmission factors.
Authors: Kangovi Shreya , Evans Tracey L. , Mitra Nandita 
Published: February 2017

48 Background: Reducing the risk of readmissions is an important quality goal for hospitals. Little is known of the perspectives of patients on underlying challenges that may lead to readmission. The objective of this study was to elicit perspectives of readmitted oncology patients on barriers to a successful transition from hospital to home. Methods: As part of a larger survey of readmitted inpatients, a 36-item survey was administered to 197 oncology patients readmitted to the hospital within 30 days of discharge to home. Surveys were administered at The Hospital of the University of Pennsylvania (an urban tertiary care academic medical center) and Penn Presbyterian Medical Center (an affiliated urban community hospital), both located in Philadelphia. Responses were entered in real-time into the electronic medical record (EMR) and used by the care team to address patient concerns and improve quality. Results: 45.2% of readmitted oncology patients reported challenges during the transition from hospital to home which they perceived as contributing to readmission. The most commonly reported transition challenges within the oncology population included difficulty with activities of daily living (ADLs) (17.8%), feeling unprepared for discharge (14.2%) and difficulty adhering to medications (7.1%). 15.2% of patients could not identify any modifiable factor contributing to readmission and reported returning simply because of symptoms from progressive illness. After adjusting for potential confounders (age, gender and severity of illness) using multivariable logistic regression models, uninsured and Medicaid patients were more likely than other patients to attribute readmission to difficulty accessing medications (OR 4.5, 95%CI 1.0, 19.9) and performing ADLs (OR 2.7, 95%CI 1.18, 6.1). Conclusions: Understanding challenges reported by readmitted oncology patients may enable inpatient oncologists to tailor transitions interventions to patient needs. Specifically, ensuring patients are able to perform necessary ADLs, are prepared for discharge and have assistance with medication adherence may help prevent unplanned readmissions. Uninsured and Medicaid patients may require additional assistance with accessing medications and ADLs.
Copayment assistance and adherence to prescription medication among patients with cancer.
Authors: Zullig Leah L. , Peppercorn Jeffrey M. , Schrag Deborah , Taylor Donald H. , Zhong Xiaoyin , Samsa Gregory , Abernethy Amy Pickar , Zafar Yousuf 
Published: February 2017

57 Background: The relationship between prescription medication adherence and copay assistance is understudied and directly impacts quality of care. Methods: We conducted a cross-sectional survey study assessing patient-reported failure to take medication as prescribed (nonadherence) and application for copay assistance. Participants were enrolled between 6/2010-5/2011 from the HealthWell Foundation (a copay assistance program) and Duke Cancer Center. Eligible patients were adults receiving treatment for a solid malignancy. Nonadherence was defined as taking a less than prescribed amount of medication, not filling or partially filling a prescription, or taking medications prescribed for someone else. Adherence and receipt of copay assistance were not linked to a specific drug. Logistic regression assessed the association between medication nonadherence, copay assistance application, and financial burden. Results: Among 258 participants, 75% applied for copay assistance. 38% (n=99) reported nonadherence with medications due to cost. Compared to adherent participants, nonadherent participants were more likely to: ask their doctor for a less expensive medication than prescribed (p<0.001); reduce spending on basics like food or clothing to pay for medication (p<0.001); purchase an over-the-counter drug to replace a more costly prescription (p<0.001); borrow/use credit to pay for medications (p<0.001); and talk with doctors about treatment-related costs (p=0.014). In adjusted analyses applying for copay assistance did not change odds of nonadherence. Having a prescription drug plan (OR 6.56, 95% CI 1.69-25.53) and utilizing coping strategies (OR 2.72, 95% CI 2.03-3.65) increased odds of nonadherence; older age (OR 0.93, 95% 0.88-0.98) decreased odds of nonadherence. Conclusions: Medication nonadherence due to cost was prevalent among cancer patients whether or not they applied for copay assistance. To afford medications cancer patients adapted their lifestyles and altered their care. Future research should investigate whether underinsured patients have timely access to copay assistance programs and whether copay assistance impacts the quality of care.