bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient safety in Danish cancer care: Results from complementary studies.
Authors: Knudsen Janne Lehmann , Lipzack Henriette , Sperling Cecilie , Sandager Mette 
Published: February 2017

216 Background: Cancer care has been a top political priority in Danish health care for the past 12 years, but there has been no specific attention towards patient safety. During the past three years, the Danish Cancer Society has carried out several studies, and in 2011 a National working group with all central stakeholders was established together with the Multidisciplinary Cancer Groups. The aim is to provide an overview of safety hazards during the cancer journey based on four different studies addressing the perspective of the health care professionals as well as the patients, and to outline the challenges in the monitoring safety in cancer based on these. Methods: Data from four studies will be presented: (1) 2,429 cancer related adverse event reports from the national Danish Patient Safety Database; (2) retrospective chart review identifying harm in 572 patient records in five inpatients cancer settings using the Global Trigger Tool; (3) errors experienced by 4,262 patients participating in a nationwide survey addressing needs and experiences with healthcare from first contact until completion of primary treatment; (4) errors experienced by the same group of patients during follow-up and rehabilitation two years after diagnosis. Results: The hazards measured varies from according to the methods used; The cancer specific AE reports were primarily related to medication, clinical, process documentation, and clinical administration. Physical harm using GTT was identified in 28% of admissions related to clinical processes, infections, and medication. 10% of the patient reported errors during contact with GP, 15% during diagnostic at hospital and 25 % during treatment. Delay, insufficient information, medication errors, and logistic errors were the most dominant errors. The results adressing patient experienced errors during follow-up and rehablitation are being analyzed. Conclusions: There are specific and serious safety challenges in cancer care and systematic monitoring is needed. Asking the patients add new knowledge. There is a need for critical evaluation of which methods to use for measuring.
Impact of a cancer management program.
Authors: Hoverman J. Russell , Klein Ira , Harrison Deb , Hayes Jad , Garey Jody S. , Nelson Greg C. , Sipala Maria , Houldin Scott , Ciaglo John , Taniguchi Cynthia , Jameson Melissa , Abdullahpour Mitra , McQueen Jessica , Verrilli Diana K. , Beveridge Roy 
Published: February 2017

227 Background: US Oncology, Inc., Texas Oncology (TxO) and Aetna are engaged in a pilot program, Innovent Oncology (IOP) to evaluate clinical and financial impacts of Pathways (PW), a nursing call intervention for chemotherapy patients (pt support services-PSS), and an advance care planning (ACP) initiative. We report quality initiatives, PW compliance and ACP, from the program at 18 months, and IP and ER admits at 12 months. Methods: Eligible Aetna pts with PW diagnoses, treated by TxO were enrolled. PW compliance was tracked. PSS calls occurred at regular intervals during chemotherapy. Symptoms, quality of life, and depression were screened each call with referrals to TxO as needed for management. ACP was initiated in month 2 of IOP. To support IOP, a leadership team comprising physicians, pharmacists and nurses was established. IP,ER data on predefined subgroups were compared to diagnosis-adjusted rates from the baseline prior year. Results: The program enrolled 184 patients from June 1, 2010 – Decembe 30, 2011 with 278 regimens ordered. Pathway adherence improved from 67% to 75%. 81% enrolled in PSS; of these, 83% were introduced to ACP, with 11% (n=16) completing a full ACP discussion. PSS made 906 calls to pts and assessed pain at 80% of contacts. IP, ER utilization rates after 12 months of IOP are reported (see Table). Conclusions: This is a preliminary evaluation with small numbers. Results suggest cancer patients can be identified pre-treatment; a proactive nurse call system is feasible and well received; a symptom assessment tool can be systematically implemented, communication on ACP initiated; and a pathways program enhanced. A reduction of ER visits by 39.8%, IP admits by 16.5 %, and inpatient days/member by 35.9% are very promising trends. A bootstrap shows 97% of scenarios with IP utilization reduction, and 96% with ER utilization reduction. [Table: see text]
Patient-centered wait time measurement in Ontario.
Authors: Kaizer Leonard , Krzyzanowska Monika Karolina , Hertz Sherrie , Srigley John , Dobranowski Julian , Irish Jonathan , Warde Padraig Richard , Gao Julia 
Published: February 2017

233 Background: Since 2005, a concerted effort to measure and manage access to chemotherapy services in Ontario has resulted in a significant reduction in several specific wait time intervals (referral for medical oncology consultation and medical oncology consultation to first treatment). To identify other opportunities to improve access, a comprehensive analysis of the all-inclusive wait times from cancer diagnosis to the start of adjuvant chemotherapy for patients with early stage colon, breast, and lung cancer (patient centered wait time) has been undertaken. Methods: The study cohort comprised all Ontario patients who received adjuvant chemotherapy in 2009 for early stage colon, breast, and lung cancers. The Ontario Cancer Registry, linked to several administrative healthcare databases in Ontario, was used to identify the cohort and variables of interest. Wait time from diagnosis of cancer to the initiation of adjuvant chemotherapy was measured and separated into segments based on the dates of diagnosis (D), surgery (S), referral to medical oncology (R), medical oncology consultation (C), and first adjuvant chemotherapy treatment (T), and each was analyzed for variation at a regional and institutional level. The times from surgery to pathology sign-out (TTPR) and for peripherally inserted central catheter (PICC) acquisition were also studied in a subset of cases. Results: In 2009, 86% of patients with stage III colon cancer, 80% of patients with stage I to III breast cancer and 63% of patients with stage II lung cancer who received adjuvant chemotherapy started their treatment within 120 days of diagnosis. There was significantly better performance and less regional variation for colon cancer patients (82-93%) than for breast cancer patients (63-90%). For the whole cohort of breast cancer patients, the median total time from diagnosis to adjuvant chemotherapy was 81 days with the following segmental breakdown D-S (30 days), S-R (19 days), R-C (16 days), and C-T (16 days). The mean TTPR for colon cancer patients was 11.6 days and PICC insertion was < 7 days in 92% of patients. Conclusions: A number of opportunities for process improvement were identified, including shortening the pathology reporting interval and the timing for initiating referral to a medical oncologist.
Measuring adverse event rates in oncology inpatients using trigger tools: An assessment of measurement properties.
Authors: Mattsson Thea Otto , Brixen Kim , Knudsen Janne Lehmann , Herrstedt Jorn 
Published: February 2017

235 Background: The Institute for Healthcare Improvement developed the Global Trigger Tool (GTT) for measuring harm rates over time in 2006. Few studies have been published on the measurement properties of GTT and no studies have assessed the value of adding specific modules to the generic GTT. We, therefore, aimed to determine inter-rater reliability, and to evaluate the effect of interrater variation on the reliability of the generic GTT to detect adverse event rates over time. Furthermore to evaluate the effect of adding an oncology specific module to the generic GTT on number and category of adverse events (AEs) identified. Methods: A retrospective chart review was performed by two teams consisting of two primary reviewers. One team used the general GTT, and the other used an oncology specific GTT (GTTO); consisting of the general GTT module plus an additional oncology module. A random sample of 10 charts was selected every two weeks between all discharged patients from a Department of Oncology in 2010. n=240. All charts were reviewed by both teams using standard GTT methods and measures. AEs per 1,000 admission days and AEs per 100 admissions where used to draw Statistical process control (SPC) charts for evaluation of the patient safety process. Inter-rater variability between review teams was assessed calculating the Kappa Cohen coefficient using data from the identical general GTT module. Results: Reliability between the two teams of reviewers to identify an AE was moderate [K=0.45]. A comparison of SPC charts, using the results from the identical general module, showed that moderate agreement gave rise to different conclusions on the patient safety process between teams. Comparing GTT with GTTO we found no significant difference (CI 95% [0.06-0.08]) in number of identified AEs and an equal distribution of the events on harm categories. GTT and GTTO identified 56 and 57 AEs respectively. Conclusions: Moderate agreement between review teams gave rise to different conclusions on the patient safety process suggesting limited use of the GTT to track harm rates over time. Addition of an oncology specific module showed no significant effect on the total number or distribution of AEs on harm categories.
An analytic framework for capturing trends in utilization, costs, and quality metrics in cancer patients’ last 6 months of life.
Authors: Cassel Brian , Skoro Nevena , Kerr Kathleen , Shickle Lisa , Del Fabbro Egidio , Coyne Patrick J. 
Published: February 2017

240 Background: Increasingly, reimbursement models are shifting to bundled payments and pay-for-performance models. While cancer care is often profitable for hospitals in the fee for service model, it is important to monitor outcomes that could influence reimbursement, such as 30-day readmissions; possible indicators of poor quality, such as 30-day mortality admissions; and to utilize longitudinal measures of costs and revenues. Methods: We evaluated trends in the outpatient and inpatient care at an academic cancer center for patients across their last 6 months of life. All-payor hospital claims data were linked to Social Security Death Index data to determine patients’ date of death even if they did not die in-hospital. All utilization at our center was analyzed for the 3,128 cancer patients who died between January 2009 and June 2011. Results: Admissions increased over the final six months, with sharp increases in ICU and total bed days in the final three months. 31% of admissions were 30-day re-admissions; 40% had a negative net margin; and all (1,178) in the final month were 30-day mortality admissions. 63% of hospice referrals occur in the final month. Conclusions: With each month this hospital is increasingly exposed to the risks of 30-day mortality and 30-day readmissions. Are the escalating costs and risks justified in terms of outcomes or quality? These findings reinforce the need for care practices that ensure that care is aligned with patient and family preferences, and that alternate care options are available and presented to patients and families in a timely fashion. [Table: see text]
Analysis of stage of melanoma diagnosis in relation to insurance type and income as an indicator of early/late diagnosis.
Authors: Lamie Peter Makram , Sikora Asia , Silberstein Peter T. 
Published: February 2017

243 Background: This study compares the average stage of diagnosis for melanoma by insurance status and household income. This is the largest such study for melanoma to date. Methods: Using the National Cancer Database (NCDB) we examined 299,214 patients with melanoma between 2000 and 2009 at 1,408 hospitals. The relationship of average stage of diagnosis is compared across insurance types and by income for 293,438 patients. Results: The VAH patient population had the lowest average stage of diagnosis (0.89) with the Medicaid population exhibiting the highest (1.87, p<0.0001). The VAH was lower than Tricare which had an average diagnosis of 1.11 (p<0.0001), private insurance 1.20 (p<0.0001), Medicare 1.34 (p<0.0001), and uninsured 1.70 (p<0.0001). The lowest rate of stage IV was private insurance (3.31%), with Tricare at 3.67% (p<0.0001), VAH 4.46% (p<0.0001), Medicare 5.74% (p<0.01), uninsured 10.12% (p<0.0001), and the highest rate was among Medicaid (14.35%, p<0.0001). The highest income category (≥$49K) had the lowest average stage at diagnosis of 1.16 compared to $39K to $48K (1.28, p<0.0001), $33K to $38K (1.35, p<0.0001), $28K to $32K (1.40, p<0.0001), and the lowest income group (<$28K) had the highest average stage of diagnosis (1.46, p<0.0001). The rate of Stage IV diagnosis increased from the highest income group (3.68%), followed by $39K to $48K (4.69%, p<0.0001), $33K to $38K (5.17%, p<0.0001), $28K to $32K (5.89%, p<0.0001), and less than $28K (6.92%, p<0.0001). Conclusions: Overall, VAH patients, higher income patients and patients with private insurance were diagnosed with earlier stage melanoma as compared to those with no insurance and Medicaid, who were more frequently diagnosed with stage IV disease. The VAH provision of high quality care, particularly preventative care, can result in improved patient outcomes such as cancer survival (Landrum et al, 2012). Reference: Landrum MB, Keating NL, Lamont EB, et al. Survival of Older Patients with Cancer in the Veterans Health Administration versus Fee-for-Service Medicare. Journal of Clinical Oncology, April 2012, 30(10): 1072-1079.
Staging documentation accuracy and adherence to workup and treatment guidelines: The M. D. Anderson Regional Care Center experience.
Authors: Sarma Amitabha , Patel Sunil M. , Sturdevant Laurie , Ip Mee-chung Puscilla , Hundley Carol L. , Kian Leslie , Simeone William , Fisch Michael 
Published: February 2017

244 Background: MD Anderson Cancer (MDACC) disease-specific faculty experts have developed institutional guidelines for diagnostic workup and treatment of common tumor types. The institution has four Regional Care Centers in suburban Houston staffed by a total of 10general medical oncologists. The primary intent of this project was to measure the accuracy of staging documentation and adherence to guidelines. The secondary intent was to improve documentation and guideline adherence by regularly reporting results directly to the involved physicians. Methods: Between July 2009 and April 2012, charts for all new medical oncology visits for patients with breast, non-small cell lung, or colon cancer for whom no previous medical oncology plan had been implemented were reviewed by a team of quality nurses on a weekly basis. Source documents were analyzed for (a) adherence to MDACC diagnostic workup guidelines (n=782); (b) accuracy of both TNM and AJCC staging documentation (n=782); and (c) adherence to MDACC treatment guidelines (n=731). On a monthly basis, a graph with rates over time of guideline adherence and accuracy of staging documentation was provided to each general oncologist. Results: The adherence rate to MDACC diagnostic workup guidelines was 79%. The agreement rate for accurate documentation of both TNM and AJCC stage was 72%. The adherence rate to MDACC treatment guidelines was 94%. Providing monthly reports of individual results to each physician did not lead to an increase in the rates of adherence of accurate staging documentation. Analysis comparing all Regional Care Center medical oncologists (not provided to the involved physicians) showed significant variation in rates for all three categories. Conclusions: Providing MDACC Regional Care Center general medical oncologists with simple graphs over time reflecting guideline adherence and accuracy of documentation did not lead to any improvement on those measures. More creative interventions to improve performance in these realms will need to be explored.
Quality of systemic cancer therapy in routine care: What are we measuring?
Authors: Shen Shixin (Cindy) , Krzyzanowska Monika K. 
Published: February 2017

249 Background: While clinical trials provide efficacy and early safety information regarding systemic cancer therapy (ST), most cancer patients who receive ST are treated outside clinical trials. We performed a systematic review of studies that have evaluated the quality of ST in routine practice to summarize the literature and define knowledge gaps across five quality domains – access, treatment delivery, toxicity, safety and outcome. Methods: We searched MEDLINE using a combination of terms pertaining to ST, such as “chemotherapy” with keywords related to healthcare quality for articles published in English from January 1, 2000 to December 31, 2010. Articles were included if they were based on original studies that examined quality of ST among adult patients from a population perspective (defined as multiple institutions). Study information was abstracted using a standardized form. Summary statistics were used to describe the results. Results: Our search identified 179 articles. The number of studies published each year increased over time from nine studies in 2000 to 30 in 2010. Most studies were conducted in the United States (58%) in either colorectal (31%) or breast cancers (27%) and focused on adjuvant intent cytotoxic chemotherapy (81%). Majority of the studies retrospectively (92%) identified patients from cancer registries (83%) and used either billing data (64%) or information in the registry itself (27%) for treatment identification. 66% of the studies evaluated a single quality domain, whereas the remaining articles assessed two or more domains. No study was found that examined safety from a population perspective. Access was the most frequently evaluated domain (77%) whereas treatment delivery was the least examined (12%). Treatment toxicity and outcome were evaluated in 21% and 31% of studies, respectively. Among studies that assessed outcome of ST, most evaluated patient specific outcomes such as survival (93%) although a few (13%) examined system level outcomes such as cost. Conclusions: Majority of studies evaluating quality of ST have focused on access to cytotoxic chemotherapy in early stage disease. Further studies focusing on other aspects of quality and in different clinical settings are needed.
Causes of chemotherapy infusion delays: Results of a time study in an academic cancer clinic in the community.
Authors: Altomare Ivy , Moss Lisa , Kamal Arif , Sutton Linda 
Published: February 2017

251 Background: Chemotherapy administration is a complex process involving several steps and checkpoints. Any of these can improve or delay efficiency in patients receiving timely care. We conducted a time study auditing delays to the start of chemo infusion to determine the main causes of treatment delays and identify areas for improvement. Methods: Within the Duke Oncology Network (DON), an outreach network assisting rural cancer clinics with clinical operations, we identified one site for the study. A DON nurse practitioner and chemotherapy nurse analyzed records from 157 patients who received intravenous (IV) chemotherapy from January to March of 2011. We collected data on timepoints from administrative schedules, nurses’ infusion records and faxes to and from the lab and pharmacy, and median times and ranges were calculated. Results: Causes of chemotherapy infusion delays can be investigated through usual patient and operational documentation. Clear and accurate data could be obtained regarding patient arrival times, time seated in infusion chair, time IV access was obtained, times labs were sent/resulted, times chemotherapy drugs were requested/received and times infusions were started. The longest delays generally involved the earlier steps, including from arrival to treatment start (see Table). Surprisingly, a thorough search did not find any literature-based benchmarks for comparison. Conclusions: It is logistically feasible and clinically helpful to conduct a time study of chemotherapy infusion delays by compiling data from timepoints available in infusion records, admin notations and faxed reports. Interestingly, in our study lab and pharmacy turnaround times were not the main cause of delays as initially expected, nor were MD visits. We identified concrete areas for improvement and will use this data to design a plan for administrators, nurses and clinicians to reduce delays to infusion start by 50%. [Table: see text]
Measuring and reporting on system performance across the Canadian cancer control continuum.
Authors: Rahal Rami , Forte Tonia , Klein-Geltink Julie , Lockwood Gina , Sandoval Carolyn , Bryant Heather E. ,   in collaboration with the System Performance Steering Committee and Technical Working Group
Published: February 2017

254 Background: The Canadian Partnership Against Cancer’s System Performance initiative is a national, collaborative effort, aimed at reporting pan-Canadian system performance indicators across the cancer control continuum to inform system-wide quality improvements. Methods: This work involved prioritizing indicator development to address quality and cancer continuum dimensions, defining and adopting standardized methodologies, and collecting validated, comparable data from provincial and national sources. Results have been disseminated though a number of general and special topic reports and have been used by policy makers and planners to identify and interpret gaps, variations, and trends to inform quality improvement strategies. An independent evaluation of the impact of this work was conducted in 2012. Results: The Reports, published annually since 2009, include a broad range of performance indicators on prevention, screening, diagnosis and treatment, research, patient experience, survivorship, supportive care, and long-term outcomes. Results show notable differences in performance by province, age and gender, geography (urban/rural), and socio-economic status, including significant variations in clinical practice patterns and concordance with evidence-based surgical, radiation, and systemic therapy guidelines. These are examined along with population risk factors, screening rates, and wait times, to assess relationships with outcome measures, including patient reported outcomes. Special studies, including chart reviews, have been conducted to explain variations, set performance targets, and to help focus quality improvement efforts. The impact evaluation identified substantial uptake of system performance information across the country and a range of specific initiatives informed by the work. Conclusions: This work represents one of the most comprehensive efforts of its kind involving all provincial and national jurisdictions in the sharing and dissemination of standardized performance results, the development of evidence-based national performance targets, and coordinated efforts to use this information to inform system-wide quality improvements in cancer control.