bluuebunny/crossref_metadata_2025_split huggingface dataset:
Educational program for medical residents in cancer pain management.
Authors: Ravisankar Shyam , Eris Ela , Cohen Alice Joy 
Published: April 2017

198 Background: Studies have shown significant deficits in the knowledge of physicians in Cancer Pain Management (CPM). We implemented an educational program on CPM for medical residents with pre and post-testing to assess baseline knowledge and the improvement after education. Methods: The content of the lecture was derived from the Cancer Pain Education Resource (CAPER). It included assessment, non-pharmacological interventions, equi-analgesic conversions , titration, side effects, withdrawal, dependence and addiction. An online questionnaire was created to assess the baseline knowledge and the residents accessed it using their mobile phones. After the lecture the same was used to assess the improvement in knowledge. 22 residents from Newark Beth Israel Internal Medicine Residency Program participated in the lecture and the pre/post-tests. After the lecture, they were given a pocket card with opioid equi-analgesic dosing calculations.Two months later, the same questionnaire was used to assess the retained knowledge. Results: The pretest score was 71% and after the lecture it improved to 81%. After 2 months the score was 72%. Notably, the knowledge of equi-analgesic conversions had increased. 95 % of the residents were very satisfied with the lecture and wanted more education on CPM. Improvement in knowledge on specifics of CPM are shown in Table. Conclusions: One of the ways to improve CPM is to focus on education of residents. After a single lecture, there was improvement in all areas of deficiency.The use of simple tools like pocket cards can help to improve knowledge. Our plan is to expand this program to medical students and have additional lectures. We believe that these lectures will improve the quality of CPM in patients. [Table: see text]
Total healthcare, treatment, and supportive care costs among metastatic pancreatic cancer (MPC) patients (pts) treated with either nab-paclitaxel/gemcitabine (nab-P+G) or FOLFIRINOX (FFX) in the first-line (1L) setting.
Authors: Ung Brian , Patel Manish , Pelletier Corey , Ni Quanhong 
Published: April 2017

20 Background: The economic burden of MPC is substantial while treatment options are limited. This study compared treatment, supportive care, and total health care costs in MPC pts who initiated nab-P+G or FFX in a large insured US population. Methods: A retrospective study was conducted using claims from the Clinformatics Data Mart Database. Adults who had ≥2 claims for PC, ≥1 claim with a secondary malignancy, completed >1 cycle of nab-P+G or FFX as 1L between 1/1/2013 and 12/31/2015, and had continuous enrollment in health plans for ≥6 months prior to and 3 months following the start of 1L, were selected. Total health care costs and MPC-related treatment costs were measured per patient per month (PPPM) during 1L. Results: 216 MPC pts met selection criteria ( nab-P+G, n=139; FFX, n=77). Pts on nab-P+G were significantly older (mean age: 67.6 vs. 61.4 years; p<0.001) vs. FFX. nab-P+G pts incurred similar total health care costs but less supportive care and treatment administration costs vs. FFX (table). The nab-P+G group had a significantly lower proportion of pts who received peg-filgrastim (13.7% vs. 50.6%; p<0.001); with lower PPPM number of fills (0.11 vs. 0.71; p<0.001), anti-emetics (92.8% vs. 100%; p=0.0154), and hydration procedures (63.3% vs. 98.7%; p=0.0001), but a higher proportion received oral opioids (66.2% vs. 54.5%, p=0.0066) during 1L. Conclusions: Total health care costs were similar. nab-P+G pts had higher chemotherapy drug costs while FFX pts had higher treatment administration and supportive care costs. [Table: see text]
Timely antibiotic administration in febrile neutropenia.
Authors: Nyatsanza Ignatius , Khan Irum , Windhorst Jennifer , Gerardo Nicole , Cadman Kasandra , Valero LeeAnn , Knightly Eileen , Feldman Lawrence Eric , Galanter William , Venepalli Neeta K. 
Published: April 2017

204 Background: The University of Illinois currently lacks a standard process to ensure timely antibiotic administration for patients with febrile neutropenia. The Infectious disease society of America (IDSA) guidelines recommend administration of antibiotics within two hours. Given the variability in patient encounters, we sought to implement an early identification and interventional strategy in the ambulatory setting for febrile neutropenic patients. A retrospective chart review over 10 weeks demonstrated that of 40 patients diagnosed with neutropenia 15 % (N = 6) had febrile neutropenia. Of these 6 patients, 50% (N = 3) received antibiotics within the IDSA time frame. We aimed to increase the percentage of febrile neutropenic patients receiving antibiotics within 2 hours from 50% to 100% in 8 weeks. Methods: A focus group at our quarterly morbidity mortality and improvement conference brainstormed a list of causes of delay in antibiotic initiation based on an index case discussion. A task force generated a pareto chart after affinity sorting the prior list, and created actual and ideal process maps, from identification of neutropenic patients to patient disposition. A standard operative protocol (SOP) was developed involving the creation and implementation of an electronic provider generated neutropenia check list triggering specific actions per IDSA recommendations, and a standardized order set including STAT cultures, and STAT antibiotics. Results: The febrile neutropenia SOP will be piloted over an 8 week period starting in early November in four ambulatory settings. The primary outcome data is the time from event to antibiotic administration. Process data will include time from event to antibiotic order, time from antibiotic order to administration and compliance with high risk neutropenic check list. We plan to assess our interventions every 3-4 weeks, and pilot at least 2 PDSA cycles within the next 8 weeks. Conclusions: Although febrile neutropenia is a recognized medical emergency with clear guidelines on treatment, not all patients may receive antibiotics within the appropriate time frame. It is therefore imperative for institutions to be aware of their level of IDSA compliance and implement appropriate quality improvements as required.
Funding model for stem cell transplant.
Authors: Monakova Julia , Tariq Huma , Hertz Sherrie , Kouroukis Tom , Blais Irene 
Published: April 2017

22 Background: A call for development of a new model for funding Stem Cell Transplant (SCT) services in Ontario led to a costing initiative described below. The new model needed to be in alignment with current costs and clinical practices, and to avoid over or under-funding the required components of care for all types of transplant (autologous, allogeneic-related, allogeneic un-related). Methods: The patient care path was broken down by transplant type into the following phases: Pre-Transplant, Graft Harvesting or Procurement, Transplant, and Follow-Up. The following Canadian and Ontario data sources were used for fiscal year 2013/14 and 2014/15 to identify costs of care: -Case Costing data submitted by the six hospitals providing SCT services, -Discharge Abstract Database (DAD), -National Ambulatory Care Reporting System (NACRS), -Other data sources, as needed (e.g. Specialized Services Oversight Information System, Health Indicator Tool). Additionally, the costs for high cost drugs, infrastructure, psychosocial support, and pathology services components were specifically identified. Broad consultation with clinical, administrative, and costing experts ensured the data was complete and appropriate to patient care needs. Once the costs for each component and phase were estimated, the funding model was developed using the bundling approach where the costs of specific activities and/or phases were bundled together for the purposes of funding. Results: The SCT Funding Model developed based on this costing initiative consists of the following four bundles covering the continuum of a patient’s care from pre-transplant to post-transplant care follow-up: 1.) Pre-Transplant, 2.)Graft Acquisition, 3.)Transplant (includes transplant and follow-up), and 4.) High Cost Drugs. Conclusions: The new SCT Funding Model reflects up-to-date costs and addresses the gaps of the previous approach. It has been implemented and is widely supported due to the extensive stakeholder engagement throughout the process. It is an important component of provincial-level planning for SCT service delivery.
Are we choosing wisely? Operationalizing Choosing Wisely in the Ontario cancer system.
Authors: Singh Simron , Earle Craig , Mittmann Nicole , Coburn Natalie G. , Rahman Farah , Liu Ning , Cheung Matthew C. 
Published: April 2017

221 Background: The Choosing Wisely (CW) campaign aims to initiate conversations about unnecessary treatments contributing to the rising cost of cancer care. We aim to develop a data linkage research platform to operationalize CW recommendations within administrative health care databases and the population-based performance of these recommendations. We initiated testing with the CW recommendiation against routine surveillance imaging in patients with aggressive histology lymphoma and pancreatic/gastric (P/G) cancer treated with curative intent. Methods: We used population-based administrative databases from Ontario, Canada to examine a cohort of adult patients with diffuse large B-cell lymphoma (DLBCL) (2004-2011) and P/G cancer post-surgical resection (2003-2013). For the DLBCL cohort, we defined an index date of 2-years after the last dose of R-CHOP as the time-frame beyond which surveillance CT imaging would be inappropriate. For the P/G cohort, the index date was 6 months post-resection. The primary outcome was cumulative incidence of CT scans within 3 years of the index date. To ensure that only surveillance scans were captured, we censored 6 months prior to development of recurrent disease, a new cancer diagnosis, or death. Results: The cohort consisted of 2,838 DLBCL and 2,930 P/G patients. The cumulative incidence of receiving CT imaging in the three years post index date was 55.6% (95% CI 53.7%-57.5%) among DLBCL and 82.8% (95% CI 81.3%-84.3%) among P/G patients. DLBCL patients ≥65 were more likely to receive imaging (p<0.01) as were those with more comorbidities (p<0.01). Younger patients with P/G were more likely to receive imaging (p<0.01) as were men (p<0.01). Income and rurality did not predict for increased imaging in either cohort. Surveillance CT imaging decreased over time among DLBCL patients (p<0.01), but increased among P/G cancer patients (p<0.001). Conclusions: During a time-frame in which surveillance imaging is deemed unnecessary by the CW campaign, the practice in Ontario remains excessive. This study represents a real-world demonstration that CW statements can be operationalized within population-based administrative databases and used as quality indicators in cancer care.
Clinic level variation in emergency department and inpatient utilization in a community setting.
Authors: Panattoni Laura , Fedorenko Catherine R. , Kreizenbeck Karma L. , Greenlee Stuart , Walker Julia Rose , Greenwood-Hickman Mikael Anne , Barger Sarah , Rieke John Whitelaw , Conklin Ted , Chance Sharon , Eaton Keith D. , Guerrero Rose , Gunkel Mary , Martins Renato G. , Moorhouse Marilyn , Smith Bruce , Lyman Gary H. , Ramsey Scott David 
Published: April 2017

226 Background: Early studies of the oncology medical home suggest that intensive outpatient care (e.g. 24-hour phone triage, same-day infusion) reduces emergency department (ED) and inpatient (IP) use during cancer treatment. Little is known about which services are most cost-effective. One strategy is to measure observed variation in ED and IP rates to pinpoint care features associated with low-use clinics. This study examined clinic-level variation in ED and IP use in a community setting. Methods: Cancer registry records for Western Washington from 2011 to 2015 were linked with claims from two regional commercial insurers. Included patients were diagnosed with breast, lung, colorectal, or prostate cancer and treated with chemotherapy or radiation. All ED and IP use was tracked 1 year after treatment start using claims data. Observed clinic rates were measured as the percentage of patients with 1 or more visits. Expected clinic rates were determined from regional average rates weighted by clinic’s cancer-specific stage mix. Observed-to-expected clinic ratios were calculated and the Wilson Score test (95% CI) was used to determine statistically different rates. Results: The 18 clinics included 4,558 eligible patients (median 196 pts/clinic; range: 35-859). Unstaged lung patients had the highest ED rates (38.5%); unstaged breast had the lowest (13.3%). The highest IP rate was among unstaged colorectal (66.7%); the lowest in local breast (11.1%). One clinic had an observed rate that was significantly above its expected rate in both ED only and ED to IP. One clinic was significantly below its expected rate in both ED to IP and IP only. Conclusions: Even after adjusting for cancer-specific stage, there was sizable clinic-level variation in the percentage of patients visiting the ED or IP. Investigation into care delivery features and practice characteristics, along with further risk adjustment, may yield insights into best practices and identify clinics for intervention. [Table: see text]
CAHPS Cancer Care Survey: Development, testing, and final content of a survey of patient experience with cancer care.
Authors: Evensen Christian , Yost Kathleen J. , Keller San , Cowans Tamika , Frentzel Elizabeth , Jenkins Sarah , Egginton Jason , Arora Neeraj K. , Garfinkel Steven 
Published: April 2017

227 Background: The objective of this work was to develop a reliable and valid survey measuring aspects of cancer care important to patients to be used in both inpatient and outpatient settings, and that allows comparisons of patient experiences across treatment centers and treatment modalities (medical oncology, radiation, surgery). Other objectives included testing various modes of data collection and developing a standardized sampling methodology based on ICD diagnosis and procedure codes. Methods: We conducted focus groups with patients who had received cancer treatment and with family members of cancer patients. We convened a panel of experts representing quality improvement, oncology, shared decision-making, patient safety, and patient advocacy to obtain feedback on the development of the survey. We interviewed stakeholder groups representing oncology associations to obtain feedback on focal provider, attribution and sampling. We then conducted a field test of the survey among six cancer centers around the country, conducted psychometric analyses, revised the survey, conducted a second field test among four community oncology practices in CA, re-analyzed the data, and finalized the survey. Results: Final survey content was determined using results of the formative research, psychometric analyses, and input from the CAHPS Consortium. The core survey includes 56 questions, 23 of which map to eight composites: Provider Communication, Enabling Patient Self-management, Team Available to Provide Information, Access to Care, Care Coordination, and Office Staff. Supplemental item sets include seven items assessing Shared Decision Making, four items measuring Keeping Patients Informed, and two additional Access to Care items. Mail-only, mail-telephone mixed-mode, and web-mail mixed-mode are recommended methods of data collection. The survey and all recruiting materials are available in English and Spanish. Conclusions: The CAHPS Cancer Care Survey is a rigorously developed, well-tested, reliable and valid survey of patient experiences with their cancer care. The survey and supporting materials are available free of charge on the CAHPS website (www.ahrq.gov/cahps).
Chemotherapy use near end of life (EOL): Measuring real world benchmarks.
Authors: Kraut Joshua , Gippetti James , Peterson Dylan , Agarwala Vineeta , Revol Cindy , Fessele Kristen Lee , Abernethy Amy Pickar 
Published: April 2017

228 Background: Use of anti-cancer therapies in the last 14-30 days of life may worsen patient outcomes and increase cost; accordingly, rate of chemotherapy use near EOL is an important quality measure. Contemporary benchmarks are needed, with transparent methods describing the cohort in which the measure is assessed, and criteria for calculation. Methods: Data on chemotherapy use, mortality, and cancer diagnosis was sourced from electronic health records (EHRs) of >8,000 patients seen between 2014-2016 at two large US academic centers, for whom dates of death were available. Death dates were sourced from the EHR and public records (e.g., obituaries). Patients were grouped by diagnosis using ICD-10 codes. Rates of infusional chemotherapy receipt within 14 or 30 days of death were calculated. Results: Across 10 tumor types, 3-7% of patients received chemotherapy within 14d of death, and 6-16% received it within 30d. Rates were stable from 2014-2016 and did not differ by cancer center. Rates were highest in diseases where patients may experience rapid clinical decline near EOL: in pancreatic and rectal cancer, 30d rates were 16% and 13%. The 30d rate was lowest (6%) in kidney cancer. When the cohort was restricted to only treated patients (who received >=5 chemotherapy administrations at the center), rates of chemotherapy use at EOL increased to 6-12% (14d) and 17-28% (30d). Conclusions: This study provides baseline estimates of current rates of EOL chemotherapy use at academic centers. Transparency in methodology is critical; for example, when the whole population of cancer patients seen at a center is considered, rates are low, but when the analysis is limited to patients who received chemotherapy there, rates nearly double. Further studies should focus on whether this quality measure is a meaningful driver of patient and health system outcomes. This work also demonstrates that it is possible to assess this metric across multiple centers; this approach could be easily scaled to all oncology practices integrated in a data sharing network. [Table: see text]
Lung cancer quality of care in Uruguay: First experience in a public hospital.
Authors: Palleiro Maria Clara Rodriguez , Rodriguez Virginia , Dominguez Viviana , Salisbury Siul , Rodriguez Alonzo , Delgado Lucia Beatriz , Cuello Toledo Mauricio 
Published: April 2017

231 Background: Improvement in quality of cancer care is a strategic health objective for the Ministry of Health in Uruguay. Lung cancer is the first cancer in mortality in men and the third in women in our country, there are few reports from Latino America about quality of cancer care, in our knowledge this is the first in lung cancer. Methods: We audit a public reference center in oncology that receive about 8 percent of new cases in the country, our objective was to perform a first study in quality of cancer care in non-small cell lung cancer. We reviewed the compliance with a group of 14 indicators (six general and eight NSCLC specific) selected from literature and used in different quality programs. We performed a retrospective analysis of medical records from 408 new patients seen between January 2011 and July 2016. Results: The median age was 62 years, 72,8% were male and 27,2% females, 76,6% were stage III-IV and 23,6% were stage I-II. The median adherence rate to core indicators were 84,2 (69% to 100%). PS was recorded in 76% of cases. Pathology report was present in 71,8% and stage in 97% of medical records. NSCLC indicators had a lower adherence rate 29,8% (5% to 56,3%). 60% receive adjuvant therapy based in platins but only in 5% of patients receive cisplatin. Histologic subtype was informed in 42% of pathology samples and EGFR mutation test were performed in 56% of patient with non-squamous lung cancer. Patients were treated with chemotherapy or radiotherapy as first treatment in 65,4%, stage IV patients receive as first line platin based chemotherapy in 42,7% of cases . Time between diagnosis and first treatment initiation was 28 days and the time to symptoms initiation to diagnosis was 3 months. Conclusions: This auditory identify a high rate of compliance in general indicators, compliance with lung cancer specific quality indicators is heterogeneous. Time to diagnosis need special attention. This study identify a room to improve in lung cancer quality of care and establish a starting point to evaluate the impact of future improvement efforts.
Measuring experiences of patients with cancer with care: The SEER-CAHPS linked data resource.
Authors: Kent Erin , Lines Lisa M , Gaillot Sarah , Schussler Nicola C. , Halpern Michael , Mollica Michelle , Rincon Maria , Smith Ashley Wilder 
Published: April 2017

238 Background: Care experience ratings are recognized as measures of quality. We introduce a new resource, SEER-CAHPS, linking cancer registry data from the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) program with Medicare claims and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Methods: The SEER-CAHPS data resource includes registry data from 1973-2011 (diagnosis, incidence, mortality, and sociodemographic data), Medicare CAHPS survey data from 1998-2013 (sociodemographic, health status, and care experience ratings), and Medicare fee-for-service (FFS) claims data from 2002-2013. SEER-CAHPS includes global ratings of overall care, personal doctor, specialist, health plan, and prescription drug plan and composite ratings of doctor communication, care coordination, getting needed care, and getting care quickly. The data also contain optional survey weights to account for the Medicare CAHPS sampling design. Results: Currently, SEER-CAHPS includes 205,339 individuals with a history of cancer documented in SEER (FFS: 26,802 with a survey before cancer diagnosis, and 55,231 with a survey after cancer diagnosis; Medicare Advantage [MA]: 57,227 with a survey before cancer diagnosis and 71,436 with a survey after cancer diagnosis). The database also includes 724,965 MCAHPS respondents without cancer in SEER regions (FFS: 282,592; MA: 447,358). The data provide insights on topics including experiences of cancer patients in their last year of life; experiences of cancer survivors; experiences of dually eligible (Medicare-Medicaid) cancer patients; and the associations of guideline-concordant follow-up care with patient experiences among people with colorectal cancer. We will demonstrate project sample-size estimation and present instructions for submitting data access applications. Conclusions: SEER-CAHPS provides population-based, cancer-specific data on patient experiences and associations with both health outcomes and healthcare utilization.