bluuebunny/crossref_metadata_2025_split huggingface dataset:
Creating infrastructure to manage the maintenance of certification part IV (MOC IV) program at an academic cancer center.
Authors: Donohue Caitlin C. , Porter Julie M. , Norden Andrew David , Dalby Carole Kathleen , Davidson Suzanne , Jacobson Joseph O. 
Published: February 2017

160 Background: The American Board of Medical Specialties (ABMS) authorizes Portfolio Sponsor organizations to internally review and approve MOC IV quality improvement projects for their physicians. Dana-Farber Cancer Institute (DFCI) became the first cancer center Portfolio Sponsor in March 2013. We used the opportunity to create a central oversight and incentive structure for quality improvement projects. Methods: As part of the ABMS requirements, physicians must submit a project application, agree to meaningfully participate in a project, and personally reflect on the experience. DFCI must submit documentation of these completed requirements to the ABMS. Therefore, a multi-disciplinary team comprised of physicians, administrators, and information specialists created a user-friendly, online system to submit, track, and store MOC IV information. This web-based system is accessible via the DFCI intranet site and contains forms, feedback loops, automated emails, and reporting capabilities. Results: Three online workflows including a Project Application, a Participation Contract, and an Attestation and Personal Reflection were created. To begin the Application workflow, physicians submit an online application. A link to the application is sent to DFCI administrators with the option to return to the submitter or send the application to the Review Board. The Review Board has the option to request additional information from the submitter or approve the project to begin. Similar feedback loops are built into the other workflows as well. The submitted information is automatically saved and cataloged and can be easily queried for reporting purposes. By 2016, 25 DFCI physicians are due for board recertification and will need to earn MOC IV credit. These workflows will help this cohort and future cohorts of physicians submit information needed to earn credit. Conclusions: The physicians and administrators who have used the system enjoy the ‘save’ functionality which allows them to complete work over time, the automated emails informing them of when they have an assignment to complete, and the ease of completing web-based forms in lieu of paper-based forms.
Standardizing risk: Development of disease and regimen-specific side effect language to enhance consent and chemotherapy treatment plan.
Authors: Donohue Caitlin C. , Perry Laura , Bartel Sylvia , Elfiky Aymen , Kaymakcalan Marina Dusevic , Murphy Karen , Jacobson Joseph O. , Dalby Carole Kathleen 
Published: February 2017

162 Background: The American Society of Clinical Oncology recommends the use of a synoptic Chemotherapy Treatment Plan (CTP) to define care including outlining anticipated side effects of chemotherapy. Dana-Farber Cancer Institute (DFCI) sought to improve their existing CTP template in the Electronic Medical Record (EMR) by standardizing side effect language. While DFCI’s existing CTP template contained a side effect section, it was burdensome, requiring clinicians to develop and list the risks for individual treatments. Side effect language varied in content and length, often inaccurately depicting the risks of treatment. DFCI created standardized, disease and regimen specific side effect templates, accessible within the EMR, in order to populate the side effects section of the CTP and consent. Methods: A multi-disciplinary team comprised of physicians, pharmacists, and administrators developed side effect language for chemotherapy regimens. Through research of published materials, a pharmacist wrote unique side effect language for each regimen, translated into a 6th grade reading level. The physicians reviewed the templates for accuracy and completeness making clinical edits to doses, schedules, and risks. Administrators assessed the language for readability using DFCI’s approved Risk Lay Language and built the side effect templates into the EMR. Clinicians access the templates in the CTP section of the EMR and populate the CTP with the appropriate disease and regimen-specific language. Results: There are 36 adult solid tumor disease categories at DFCI. Side effect profiles were developed for 27 (75%) of these categories. By fall 2014, 100% of the side effect profiles will be completed and available in the EMR. In total, 612 regimens will have specific side effect language written and built into the EMR as custom paragraphs. To date, 500 (82%) of the side effect profiles are in development. Conclusions: Building standardized disease and regimen specific side effect language provides patients and clinicians with an accurate depiction of the risks of treatment; subsequently ensuring proper patient education and elimination of provider documentation burden.
Development of Smilow's EPIC ambulatory dashboard and the impact on bar code scanning compliance at care centers.
Authors: Amport Stephanie Buia , Shomsky Lisa , Lyons Catherine A. , Sterling Roberta , Smith Mandeep , Beaulieu Nancy , Corjulo Diane , Adelson Kerin B. , Chiang Anne C. 
Published: February 2017

166 Background: Barcode scanning of patient wristbands is a critical stop-gap to prevent administration errors. After EPIC go-live and the implementation of barcode scanning, we created 10 EPIC-based metric reports including scanning compliance. Prior to having reports, our clinical leadership relied on variable qualitative feedback on scanning rates. Our AIM was to reach 90% patient barcode scanning compliance by Feb, 2014 and 95% by Aug, 2014 across Smilow Cancer Hospital Care Centers of Yale-New Haven Hospital. Methods: To engage staff, we shared data on the importance of barcode scanning, compliance and related adverse event reports. Staff reported challenges with scanning patients. We engaged pharmacy leadership to rectify barcode mapping errors. Leadership shared the expectation that all patients would be scanned, that there would be spot checks to prevent workarounds, that staff would be accountable for their own performance and that of their peers, remediation plans for areas <90% compliant and use of a dashboard for employee and medication specific reports. Results: Monitoring, feedback, competition, and improved scanning equipment led to compliance increasing form 89% to 99%. Conclusions: Staff input, detailed reports and workflow review were needed for successful barcode scanning implementation. Staff knowledge that compliance was monitored, communicating improvement, and competition were required for incentive to change practice. Leaders encouraged a culture of safety by ensuring staff feedback was addressed and issues were resolved.Interdisciplinary teamwork between nursing, pharmacy, education and products was necessary to improve barcoding capability.EPIC-based metric reports can drive awareness of and improvement in quality metrics to ensure safe patient-care. [Table: see text]
An electronic prompt to improve hepatitis B virus screening prior to cancer treatment.
Authors: Hicks Lisa K. , Feld Jordan J. , Juan Joshua , Truong Judy , Zurawska Urszula , Giotis Angie , Chan Kelvin K. 
Published: February 2017

169 Background: Hepatitis B virus (HBV) reactivation is a potentially fatal complication of cancer therapy that is almost entirely preventable. Despite this, HBV screening rates remain low at many centers. We evaluated the effectiveness of an electronic prompt on HBV screening rates and compared this strategy with education alone. Methods: An education session on HBV reactivation was delivered to all oncology staff at two large, academic oncology centers in the fall of 2010. At one center (study center) an electronic prompt was also introduced. The electronic prompt reminded physicians to screen for HBV when booking a new patient’s first chemotherapy and automatically trigged an electronic order for HBsAg if the physician assented. The prompt was not implemented at the second (control) center. The primary endpoint was the rate of HBV screening. Actual HBV screening rates were determined in both centers for 10 months prior to and for 12 months following the interventions. HBV screening rates were assessed and compared with process control charts (p-charts); 3-sigma limits were employed to define special cause variation. Results: 6,116 new patients received their first chemotherapy during the study period (2,095 study center; 4,021 control center). In the pre-prompt period, the screening rate was stable at 16% at the study center and 25% in the control center. In the prompt period, the screening rate increased to 62% at the study center and was unchanged at 25% in the control center. Special cause variation suggesting a non-random improvement in HBV screening rate was detected at the Study Center two months after the introduction of the electronic prompt. Conclusions: An electronic prompt increased the rate of HBV screening, however screening rates remained relatively low. Education sessions did not appear to improve the HBV screening rate.
The use of IT to improve practice quality within a radiation oncology program.
Authors: Varghese James , Giovinazzo Julia , Larsen Tessa , Medlam Gaylene , Moran Natasha , Murphy Julie , VergelDedios Dennis , Wang Yizhen 
Published: February 2017

170 Background: Our centre has used ARIA as its oncology information system since 2005. Anecdotally, since 2008, dosimetrists have identified a high rate of replanned treatment plans. In 2010, a 2% replan rate was estimated however, it was felt that the results did not capture the true rework impact. A definition for replan was created to distinguish it from plan revisions and an attempt to standardize replan naming conventions was initiated. The replan workload was again raised as an issue in 2013 and an interdisciplinary review workgroup was formed with the objective to develop a process to capture workload more accurately. Methods: Rework was further categorized into replan, rework and revision. The nomenclature for the ARIA plan name data field was standardized to identify replans and plan revisions. In addition, rework task activities were created to identify the discipline initiating the rework. Embedding these changes into our process allowed for efficient and accurate workload data extraction. Results of monthly data analysis are shared with the dosimetrists and actionable items are sent to department heads for program engagement. Results: In March 2014, we achieved 100% compliance to the plan naming convention. Data showed 6% replan and 6.5% revision rates. Table 1 shows the rework numbers initiated by discipline. Conclusions: A paperless environment lends itself well to an organization’s ability to capture data. Our experience shows that if processes are designed to support and be supported by the information system, the input of data points can be embedded seamlessly and practically in the clinician’s workflow. This results in improved data capture where data becomes more meaningful, and can then be used for continuous quality improvement, operational decision-making and research projects, all of which can lead to practice improvements. [Table: see text]
Pathways clinical decision support for appropriate use of key biomarker.
Authors: Ellis Peter G. , Lokay Kathleen 
Published: February 2017

172 Background: UPMC CancerCenter (UPMC) has utilized clinical pathways for almost ten years in an effort to ensure standardization to the evidence based care for its patients. UPMC oncologists participate in the various pathways disease committees that develop and maintain the pathways content and utilize the pathways through a web-based portal in their daily decision making and documentation. The pathways cover not only treatment recommendations but also guidance for work up such as recurrence risk tools (OncoType Dx) for node negative, HER2 negative, ER positive breast cancer who are candidates for chemotherapy. For patients with a low recurrence risk score, the pathways recommends hormonal therapy only, saving the patient both toxicities and costs of chemotherapy where appropriate. Methods: UPMC analyzed its use of chemotherapy in patients with a recurrence risk score of less than 19 through a retrospective review of physician-input data in its Via Pathways Portal for the twelve months ended May 31, 2014. During this time period, the Via Pathways recommended the recurrence risk test for node negative, HER2 negative, ER positive patients. For patients with a low risk score (less than 19), the Via Pathways recommended hormonal therapy only. For those low risk score patients receiving chemotherapy, the physician would document that an Off Pathway decision was being made, indicate the reason for going Off Pathway, and document the actual therapy delivered. Results: For the twelve months ended May 31, 2014, UPMC physicians documented 288 decisions for patient presentation of node negative, HER2 negative, ER positive patients with a recurrence risk score of less than 19. Of these decisions, 99% (n=284) were On Pathway for hormonal therapy. Of the remaining 1%, three (3) were for accrual to a clinical trial and one (1) was Off Pathway for chemotherapy. Conclusions: Pathways are a tool for promoting adherence to evidence based care by oncologists through the use of a point of care decision support system. Pathways have the potential to reduce costs and toxicities of treatment through the evidence based guidance developed by the pathways disease committees and the adherence to such guidance by oncologists utilizing the pathways decision support tool.
Tumor boards among physicians caring for lung and colorectal cancer patients.
Authors: Kehl Kenneth L. , Landrum Mary Beth , Kahn Katherine Leslie , Gray Stacy W. , Ko Clifford Y. , Chen Aileen B. , Keating Nancy Lynn 
Published: February 2017

179 Background: Multidisciplinary tumor board meetings are an important part of cancer care, but few data are available about their benefits. We assessed the association of tumor board participation and structure with patient outcomes. Methods: We surveyed a population and health system-based cohort of patients with lung or colorectal cancer diagnosed in 2003-05 (N=9732) and their physicians (N=1601). We asked physicians how often they participated in tumor boards and whether those meetings served a treatment planning function, evaluated prior treatment decisions, reviewed only challenging cases, reviewed >1 cancer site, and/or served only as teaching sessions. Using logistic and Cox regression, we assessed associations of tumor board participation and tumor board features with patient clinical trial enrollment, receipt of guideline-concordant care, patient-reported quality, and survival. We adjusted for patient demographic and clinical characteristics and physician traits, including specialty. In this exploratory analysis, P values were not adjusted for multiple comparisons. Results: Patients treated by the 54% of physicians participating in tumor boards weekly (vs. less often/never) were more likely to enroll in clinical trials (OR 1.6, 95% CI 1.1-2.2). Patients of physicians whose meetings reviewed >1 cancer site had lower likelihood of trial enrollment (P=0.04) and, among patients with stage I/II non-small cell lung cancer (NSCLC), of curative-intent surgery (P<0.001). Patients with stage I NSCLC, extensive-stage small cell lung cancer (SCLC), or stage IV colorectal cancer had lower mortality if treated by physicians participating in tumor boards weekly (vs. less often/never, P<0.05). Stage I NSCLC patients whose physicians’ tumor boards reviewed >1 cancer site had higher mortality (P=0.04), as did patients with SCLC whose physicians’ tumor boards served only as teaching sessions (P=0.004 for limited SCLC, <0.001 for extensive SCLC). Conclusions: Frequent physician tumor board engagement was associated with patient clinical trial participation and lower mortality for colorectal, small cell lung, and early non-small cell lung cancer, diseases that may benefit from coordinated treatment delivery among specialists.
Use of imaging for staging of early breast cancer in two integrated health care systems.
Authors: Hahn Erin Elizabeth , Tang Tania , Lee Janet S. , Munoz-Plaza Corrine , Adesina Joyce O , Shen Ernest , Rowley Braden D. , Maeda Jared L , Mosen David M , Ruckdeschel John C. , Gould Michael K 
Published: February 2017

184 Background: The initial ASCO “Top 5” list, created as part of the Choosing Wisely campaign, recommends against use of imaging for staging of early stage breast cancer in asymptomatic women at low risk for metastasis. The objective of this study was to measure and compare use of imaging for staging in two large integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was used for routine staging or for diagnostic purposes. Methods: We identified stage 0-IIB breast cancer patients diagnosed between January 1, 2010 and December 31, 2012 with first primary malignancy from tumor registries in three KP regions (Southern California, Northwest, and Mid-Atlantic) and IH. Using the KP and IH electronic health records, we identified use of imaging tests (PET, CT, bone scan) during the staging window (30 days prior to diagnosis up to initial surgery). We performed chart abstraction on a random sample of patients who received an imaging test to identify indication. Results: For the total sample of 10,014, mean age at diagnosis was 60 (range 22-99); with 21% stage 0, 47% stage I, 32% stage II. Overall, 8% of patients (792 patients) received at least one imaging test during the staging window, including 8% at KP and 6% at IH (p=0.0005). Chart abstraction (N=129) revealed that overall, almost half of all imaging tests (48%) were performed to evaluate a symptom, sign or prior imaging finding, including 55% at KP and 32% at IH. Conclusions: Use of imaging for staging of low-risk breast cancer was very low in both health care systems, with clinically trivial differences between them. Approximately half of imaging services were in response to a sign or symptom. Strategies to reduce use of imaging at staging for early stage breast cancer patients within these health care systems are unlikely to yield meaningful improvement. [Table: see text]
A breast analytics dashboard to allow near-real-time visualization of quality assurance data.
Authors: Levy Mia Alyce , Warner Jeremy , Sanders Neal , Carney Pam , Pratt Joy , Cobb Jared , Taylor Ariadne , Neuss Michael N. 
Published: February 2017

186 Background: Quality metrics for internal use (e.g. quality improvement; quality assurance [QA/QI] activities) and external use (e.g. accreditation; national quality reporting) are currently primarily obtained through retrospective manual data abstraction on subsets of patients, at a majority of cancer centers. Real-time QA/QI of all patients is attractive but requires collection of electronic data from disparate clinical systems that are rarely fully interoperable. We developed a dashboard to aggregate relevant clinical information in near real-time for QA/QI visualizations. Methods: Tableau® software was used to visualize data from multiple clinical systems at Vanderbilt University Medical Center (VUMC). Custom extract, transform, and load (ETL) processes were developed to collect radiology, pathology, professional billing, and clinical data on a daily basis. An integrated dashboard was developed through an iterative process involving physicians, nurses, and software engineers. As a pilot project, data from all patients with an image-guided breast biopsy obtained at VUMC from 2009-2013 was visualized. Results: 4177 biopsies were included in the visualized cohort as of June 2014. 3,210 (77%) of the biopsies were preceded by a BiRADS 4 or 5 mammogram. The annual biopsy rate increased by 51% over the time period. Despite this increase in volume, the median number of weekdays from BiRADS 4 or 5 mammogram to image-guided biopsy was stable at 5 days over the time period. Prior diagnosis status, lesion class, procedure type, and imaging exam type were also included in the dashboard. Conclusions: This pilot project demonstrates the ability to visualize near real-time clinical data for QA/QI purposes. Tableau® is interactive, so that certain patterns (e.g. the distribution of number of days from screening mammogram to biopsy) can be explored at a granular level. This functionality also allows the user to investigate why 23% of patients had no apparent imaging before biopsy. Based on a perceived pattern of delayed biopsy in certain outliers, QI efforts at VUMC are underway to ensure timely biopsy. Interactive visual dashboards such as the one described present opportunities to rapidly cycle QA findings into QI actions.
Improving quality of pediatric cancer survivor care: Providers’ support of and experience with survivor care plans.
Authors: Warner Echo L. , Hacking Claire C , Wu Yelena , Kirchhoff Anne C. 
Published: February 2017

190 Background: Clinical integration of Survivor Care Plans (SCPs) varies. This study assessed pediatric oncology providers’ familiarity with and preferences for providing survivor care and SCPs. This research aims to inform efforts to improve the quality of pediatric cancer survivorship care through increased implementation of SCPs. Methods: From November 2013-April 2014 oncology providers (physicians n=18; nurses n=23) were recruited from the Pediatric Oncology clinic at Primary Children’s Hospital in Salt Lake City, UT. Participants completed a 25-item survey (N=41). A subset participated in a 45 minute focus group (n=17). Participants reported their familiarity with and training on survivorship care, opinions on SCP efficacy, and barriers to using SCPs. To evaluate differences in survey responses for physicians and nurses, we generated Fischer’s exact tests. Focus group transcripts and open-ended survey responses were content analyzed. Results: More oncologists reported familiarity with SCPs (94% vs. 30%, p<0.01) than nurses. Top sources of training for cancer late effects included colleagues (66%), conferences (54%) and medical journals (37%). More oncologists (35%) than nurses (5%) reported ever providing a patient with an SCP (p=0.03). Oncologists also prioritized the clinical integration of SCPs more than nurses (69% vs. 29%, p=0.02). Top perceived barriers to using SCPs in clinical practice included: not knowing enough about SCPs (67%), using SCPs not expected (54%) and no champion (49%). In the qualitative comments, providers expressed that patient age variation made timing of SCP delivery difficult. Most participants were supportive of testing an SCP intervention program (95%) and felt this effort should be done within the context of the multidisciplinary healthcare team. Conclusions: As of now, this clinic has no standard procedures for disseminating SCP and survivorship care, yet the providers we surveyed supported testing an SCP program to improve the quality of their patients’ care. The implementation of coordinated pediatric cancer survivor care should include provider training and testing strategies to implement SCPs more consistently within clinical care.