bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Canadian True NTH Initiative: A multisite intervention to improve the lives of men with prostate cancer.
Authors: Gilbert Julie , George Matthew M. , Huggins Elilzabeth D. , Rowlands Maureen E. 
Published: February 2017

118 Background: The True NTH Initiative aims to improve the lives and experiences of men with prostate cancer, as well as those of their partners, family and caregivers. In Canada, Prostate Cancer Canada selected ten teams to develop, implement and evaluate evidence-informed programs focusing on decision support, clinical support, lifestyle management, education, social support, navigation and treatment follow-up. Project teams were encouraged to align their local evaluations with a common evaluation framework and a national evaluation plan was developed. The aim of this abstract is to share methodology and early results of a multi-level evaluation that will address a range of programs designed to improve the lives of men with prostate cancer. True NTH is funded globally by the Movember Foundation, and operates in Canada, USA, UK, Australia, New Zealand, Ireland and Singapore. Methods: Projects (Solutions) selected for the initiative had existing evidence for their efficacy. Project teams were responsible for designing the implementation of their Solution and an appropriate evaluation. Local and national evaluations used a recognized framework (RE-AIM) to systematically study the real world uptake of these interventions, focusing on questions of Reach, Effectiveness, Adoption, Implementation, and Maintenance. Project teams provide quarterly narrative updates and annual written reports with quantitative measures and narrative components. Key informant interviews with project leads will complete the final national evaluation. Results: To date, projects have generated learning across different provincial health systems, academic institutions and community settings. Teams have learned to address challenges of participant recruitment and project endorsement, and have begun to appreciate the benefits of collaboration. Teams have also reflected on the importance of engaging clinicians in the implementation of their Solutions for effective uptake and sustainability. Conclusions: The results of the ongoing multi-level evaluation continue to provide insight into real world implementation of evidence-informed programs and the critical factors that enable their effectiveness.
Development and implementation of competency-based orientation program for advanced practice providers at an academic cancer center.
Authors: Dougherty David W. , Berkhof Julie Ann , Hokula Cheryl , Kozlowski Julie , Galdys Jennifer , Zimmer Nicole 
Published: February 2017

119 Background: Increased utilization of Advanced Practice Providers (APPs) has been identified as a means to increase oncology visit capacity and improve productivity. Many APPs have little experience in oncology or are new to the APP role. As a result, there is a need for a comprehensive, competency-based orientation and mentorship program to aid in this transition and ensure effective integration of APPs into the complex oncology environment. Methods: We developed and implemented a comprehensive, competency-based orientation and mentorship program for APPs hired into the Wilmot Cancer Institute. In addition to basic institutional orientation, APPs are assigned primary & secondary preceptors and complete a 12-week oncology-specific orientation that includes specific clinical activities relevant to their role. Oncology educational articles and lectures are provided and APPs meet weekly with preceptors to identify goals, accomplishments and improvement needs. Faculty mentors are assigned for additional oncology-specific and professional development, as well as oversight of chemotherapy ordering. If deficiencies are identified, APPs are provided an Individual Development Plan with milestones necessary for progression. Results: From January 2013 to July 2015, 16 APPs were hired and enrolled into the orientation program. 11 APPs had no prior oncology experience and 10 had no prior experience as an APP. 14 of 16 APPs (87.5%) successfully completed the orientation program. 2 APPs were placed on Individual Development Plans and subsequently did not complete the program. All 14 APPs successfully completing orientation have been retained in their position, leading to 100% retention rate for those completing the program since its inception. Conclusions: This framework for a comprehensive, competency-based orientation and mentorship program for APPs at an academic cancer center has improved our ability to successfully integrate APPs into the cancer care environment. In addition, APPs having difficulty transitioning or who are unable to complete the orientation were efficiently identified, leading to individualized improvement plans required for ongoing employment.
Code status documentation in the electronic medical record for patients with stage IV pancreatic cancer.
Authors: Kronenberg Daniel , Armstrong Janet M , Ma Joseph D. , Revta Carolyn , Roeland Eric 
Published: February 2017

125 Background: Improving incidence of code status documentation in the electronic medical record (EMR) has been suggested a better guidance for clinical care compared with a traditional advance directive. We have previously reported that in the absence of a template in the EMR, code status documentation was 36% and inconsistent in patients with advanced cancer. Utilizing a different cohort of patients with metastatic pancreatic cancer, we examined the prevalence of EMR code status documentation. Methods: A retrospective analysis in patients with analytic metastatic pancreatic cancer (2008-2014) was conducted at a single, academic medical center. The primary objective was to determine prevalence of code status documentation in the EMR. Secondary objectives were to determine documentation author, location in the EMR, and time from documentation until death. Patients were identified from a tumor registry and code status documentation was identified in the scanned media, demographics tab, problem list, or using key search terms in the EMR. Results: 169 patients with stage IV pancreatic cancer were identified. Seventy-five percent (n = 127) had a code status documented. Of those with documented code status, 44.9% (n = 57) were full code/full care, 22.0% (n = 28) were DNR/comfort care, 18.9% (n = 24) were DNR/full care, 13.4% (n = 17) were DNR/not specified, and 0.8% (n = 1) was limited DNR/full code. EMR locations for code status documentation included: 71.7% (n = 91) discharge summary, 10.2% (n = 13) inpatient encounter, 10.2% (n = 13) history & physical, 6.3% (n = 8) media tab, 0.8% (n = 1) telephone encounter, and 0.8% (n = 1) admission note. Code status documentation was completed by hospitalists (42.5%, n = 54), medicine residents (21.3%, n = 27), and primary oncologists (4.7%, n = 6). Mean difference for date of code status documentation and death was 67±145 d. Conclusions: Code status documentation was higher for patients with metastatic pancreatic cancer compared to patients with advanced cancer from a previous study at our institution. Research is needed to determine if full code/full care is a default selection or a true representation of a patient’s wishes. Future efforts need to consider a standardized location for code status documentation in the EMR.
Geographic practice patterns in the selection of adjuvant dose dense (DD) chemotherapy among stage 1 breast cancer (BC) patients.
Authors: Hrushesky William J. , Baum Michael , Bennett Charles L. , Knopf Kevin , Huff Dinah Faith Q. 
Published: February 2017

126 Background: Oncology Analytics (OA) reviewed drug pre-authorization requests amongst populations with similar demographic features. Small stage I, node-negative, margin-free BC may be treated by observation, hormone therapy or adjuvant chemotherapy. If chemo is used, either standard or DD schedules may be requested. Patient age, HER2 status, and ER expression affect the choice of treatment. Methods: We analyzed data from oncology drug preauthorization requests for BC protocols submitted by providers in FL, GA and TX from October 1, 2013 through September 30, 2015. Pearson chi-square was used to test for association at 95% CL. Risk was bifurcated by consideration of age, putative ER/PR status, and HER2 status. High-risk patients are those with putative ER/PR(-) status and/or Her2(+) status and/or younger than 50 years old. Results: Requests for standard and DD chemotherapy are related to the risk characteristics of the tumor. Oncologists in GA/TX prescribed a greater proportion of adjuvant chemotherapy for stage I BC patients than oncologists in FL (13.13% GA/TX vs 9.97% FL;p = 0.001). About 40% of all stage 1 chemotherapy requests are for dose-dense chemotherapy. Patients with high risk BC have a higher chance of getting dose dense chemotherapy than the low risk subgroup. FL oncologists have a higher likelihood of prescribing dose-dense chemotherapy than GA/TX oncologists (82% FL vs 65% TX p < 001) if the BC risk is high, whereas the opposite is true if the patient is low risk (8% FL vs 17% GA/TX, p = 0002). Conclusions: While these geographical differences may be random, it may also be relevant that OA has worked in Florida for six, Georgia and Texas for two years. This suggests that patients with low risk disease are less likely to get the more toxic DD therapy if OA is in a market for a longer period of time.
Utilizing an A3 project to improve assessment of oral chemotherapy adherence across a five-site enterprise.
Authors: Hepler Marjorie , Dunn Kathleen , Allen Debra Kay , Denny Diane , Markman Maurie 
Published: February 2017

136 Background: Cancer Treatment Centers of America, Inc. (CTCA) is a national network of five hospitals that specialize in treating patients fighting complex or advanced-stage cancer. During the fall of 2013, two of the five centers began the pursuit of Quality Oncology Practice Initiative (QOPI) certification. A third site began QOPI certification the spring of 2014 and the remaining two sites followed suit the spring of 2015. This process brought attention to the patient population receiving oral chemotherapy and the importance of careful monitoring of those self-administering their cancer treatment regimens. In July of 2014, before the remaining two sites began the QOPI certification process, an A3 project was introduced to the enterprise, focusing on the assessment of patients’ toxicity and adherence to their oral chemotherapy regimen. The initial data suggested either a lack of documentation or missed opportunity for patient education with baseline performance data at 7.8% across the sites. Methods: Using A3 problem solving and education of care management teams at each site, a policy was composed and processes put in place to engage nursing in conducting follow up via telephone for those patients newly prescribed oral chemotherapy. This also included use of an acronym featured in the EHR to ensure appropriate documentation. Random chart reviews occurred monthly to monitor progress and to provide feedback to the nurses on proper documentation of assessment of adherence and toxicity. The goal was to attain a 60% composite score across the five centers with a score of 62% achieved, signifying a 694% improvement. Results: Once the patient received the oral chemotherapy, the care manager placed weekly calls to assess adherence and toxicities. Composite scores for fiscal year 2015 show a marked increase in the documentation of assessment of adherence in patients receiving oral chemotherapy. Conclusions: Involvement in problem solving and ongoing education of nursing regarding importance of assessment of adherence and toxicities of patients receiving oral chemotherapy significantly improves documentation ensuring high quality safe care. [Table: see text]
Improving screening and prophylaxis of Hepatitis B in immunosuppressed patients.
Authors: Ichiuji Mary Mitsuko , Rabrenovich Violeta , Baer David M. , Schottinger Joanne E. 
Published: February 2017

139 Background: Kaiser Permanente (KP) is an integrated health care delivery system that provides clinical services to over 10 million members in nine states and the District of Columbia. Since 2007, KP oncology community collaborates at the national level to systematically improve safety and quality of care. Our improvements are accelerated by rapid adoption of evidence based protocols, leveraging of EMR and integration of quality improvement methods into clinical operations. Methods: KP created a team that included oncologists, hepatologists, rheumatologist, pharmacy, and quality improvement experts to evaluate safety of existing practice. Based on internal findings, we decided to focus on screening and prophylaxis of Hepatitis B in immunosuppressed patients. Hepatitis B primary infection can be self-limited with viral elimination and lasting immunity or can result in a state of chronic infection with persistent viremia. Hepatitis B can be reactivated with, or after withdrawal of, immune suppressive cancer therapy. Reactivation can result in clinical hepatitis, treatment interruptions, and not infrequently death from fulminant hepatitis. The goal of this initiative is to save lives (i.e. track % patients on chemotherapy who were not tested for Hepatitis B surface Antigen and Hepatitis B core Antibody and for those with a positive test, to determine if they received appropriate prophylaxis). Results: The multidisciplinary group initiated interventions: 1) Defined the patient safety measure of a rate of patients on anti-CD 20 therapies who had a Hepatitis B test prior to therapy; 2) Completed a baseline analyses and shared results with KP regions for appropriate actions; 3) Created an alert and incorporated into KP oncology/ rheumatology Beacon module; 4) Developed KP National screening and prophylaxis resource for hepatitis B in immunosuppressed patients; 5) Developed capacity for ongoing monitoring. Conclusions: We determined a need to educate clinicians and to standardize recommendations for screening and prophylaxis of Hepatitis B in patients receiving Anti-CD20 therapy. Changes were instituted in the Beacon protocols to check baseline labs. Ongoing surveillance using a safety net will be developed.
Economic evaluations of patient-navigation programs in cancer care.
Authors: Gerves-Pinquie Chloe , Girault Anne , Sicotte Claude , Minvielle Etienne 
Published: February 2017

14 Background: Lack of coordination is challenging our health care systems. This is especially true in cancer care, which is based on multiple treatment alternatives and several types of patient-professional interactions. One recommendation is to develop patient navigation programs based on telemedicine in order to avoid costs that are due to under-coordination among providers and/or between patients and providers. The objective of our study was to identify the evidence on the economic impact of such programs in oncology, and to develop a methodological framework to conduct economic evaluations. Methods: We conducted a literature review, exploring articles indexed in Medline (2005-2015), and focusing on economic evaluations of navigation programs in oncology, with particular attention to the use of telemedicine. Results: Of the 14 studies included, nine were randomized controlled trials. Four studies adopted a societal perspective. Every study computed the direct costs of the program. Six studies included indirect costs in the total costs associated with the program, mainly based on patient productivity loss and travel cost. Only two papers included indirect costs associated with informal care. Two studies showed that patient navigation programs were less costly than standard care. Most of the total cost of patient navigation is attributable to direct medical costs (i.e. patient admission, diagnostic follow-up and medical intervention). Conclusions: More evidence is needed regarding the economic impact of navigation programs in oncology. This review provides some guidance for the design of economic evaluations. If these programs are funded through public resources, a societal perspective should be adopted since it covers the direct, indirect and intangible costs of the program. Furthermore, a key strategy will be to identify the most common situations of under-coordination occurring alongside the usual care pathway and measure avoidable costs. This advocates for an extended use of economic evaluations based on randomized controlled trials.
Effects of admission (adm) source, time, and provider on inpatient (inpt) oncology (onc) outcomes at the Cleveland Clinic Foundation (CCF).
Authors: Christopher Wee , Goodman Lindsey Martin , Rybicki Lisa A. , Montero Alberto J. , Estfan Bassam N. , Best Carolyn , Stevenson James 
Published: February 2017

140 Background: The quality of care transfers is known to influence clinical outcomes. In an inpt onc setting at a major tertiary care referral center, patient (pt) adm originate from many different areas and times. A detailed evaluation of onc adm by source of transfer, admission time, and provider type, may identify opportunities to improve inpt clinical outcomes. Methods: We retrospectively reviewed all adm to the inpt solid tumor onc service from July - December 2014 from CCF regional hospital emergency departments (ED), outside hospital (OSH) ED, OSH inpt services, and CCF outpt clinics. Pts were excluded if the adm was planned or if admitted from the CCF Main Campus ED. Data collected included pt and encounter characteristics and provider type (house-staff or nocturnal hospitalist). Clinical outcomes, including activation of the adult medical emergency team (AMET), ICU transfers, length of stay (LOS), and in-hospital mortality were compared using chi-squared test; ECOG PS and LOS with the Kruskal-Wallis tests and Wilcoxon rank sum test. Results: A total of 413 unique pt admissions were reviewed. 213 were included after exclusion criteria were applied. The probability of AMET activation, mortality, and LOS differed by origin of transfer. Pts admitted from CCF regional EDs had the lowest median LOS and no deaths. OSH int transfers demonstrated significantly higher mortality vs other origins of transfer. Pts whose first orders were placed after 5pm had no significant differences in AMET activation, ICU transfers, LOS, or mortality vs daytime adm. There were no differences in adverse outcomes by the type of admitting provider. Conclusions: Onc inpts transferred from an outside healthcare setting were at highest risk for adverse outcomes (AMETs, increased LOS, and mortality) include those originating from OSH inpt services. Process and communication interventions focused on transfers from outside inpt facilities may improve safety and outcomes in this population. [Table: see text]
Safety of using escalated doses of enoxaparin prophylaxis in adults with acute lymphoblastic leukemia receiving asparaginase-based intensification therapy.
Authors: Sibai Hassan Abdulmaoula , Seki Jack Toshimine , Wang Tian , Saini Lalit , Stessman Andrew , Samuel Joseph , Sakurai Naoko , Schuh Andre C. , Yee Karen W. L. , Minden Mark D , Schimmer Aaron David , Gupta Vikas , Shanavas Mohamed , Brandwein Joseph M. 
Published: February 2017

141 Background: Venous thromboembolism (VTE) is a known complication in adults receiving asparaginase (ASNase) for acute lymphoblastic leukemia (ALL). We previously reported a 27.3% VTE rate in patients (pts) receiving a modified Dana Farber Cancer Institute (DFCI).We report updated results using two different dosing of enoxaparin as primary VTE prophylaxis. Methods: 62 pts ALL in complete remission, who were treated with a weekly ASNase-based DFCI intensification phase for at least 7 cycles (21 weeks) and received prophylaxis with enoxaparin targeted to 1 mg/kg subcutaneously (SC) daily (escalated dose group), were evaluated . Results were compared to a similar group of 41 patients who had received enoxaparin 40 mg for patients weighing less than 80 kg, and 60 mg for those 80 kg and above (low-dose group), and to a similar group of 99 pts previously treated with the same DFCI protocol without anticoagulation prophylaxis. Results: The actual mean dose of enoxaparin in the low-dose prophylaxis group was 0.62 mg/kg, as compared to 0.88 mg/kg in the escalated dose group. There were no major bleeding complications observed in the prophylaxis groups. The minor bleeding rate in the entire prophylaxis cohort was 4.8% (5/103), and was similar between the low-dose and escalated dosing groups. The VTE entire cohort that received prophylaxis was 20% (21/103). The VTE rates for all groups as shown in the table. Conclusions: Overall use of prophylactic enoxaparin during intensification in adults with ALL receiving ASNase was safe; escalating the enoxaparin dose to 1 mg/kg, did not increase the number of bleeding events. There was a trend toward a lower rate of VTE using dose-escalated enoxaparin, particularly in patients weighing < 80 kg. [Table: see text]
Time stamps used to measure the patient's clinic experience.
Authors: Jensen Terry , Brown Roy , Riegel Gay , Wilfong Lalan S. , Hoverman John Russell 
Published: February 2017

150 Background: In 2013, a patient reported satisfaction survey indicated 19% of patients waited 20-40 minutes, 8% 40-60 minutes and 4% over 1 hour. We initiated a project to objectively quantify the components of wait times to investigate opportunities for improvement. Methods: Utilizing existing technology in the practice management system, clinic staff use the Day List feature to capture time stamps as patients move through the clinic. We focused on provider appointments but these visits could also include business office, labs, infusion and diagnostics. It was important to define where the wait(s) occurred. The Time Stamp durations measured are as follows: Arrival to Depart – duration of each appointment; Arrival to site to Exam Start – duration of activity until ready to be seen by the provider, includes rooming, labs and business office activity. Used to compare to the patient satisfaction survey responses; Exam Start to Depart – the provider portion of the office visit, includes patient wait plus exam time. Three reports are generated: Time Stamp Error Report indicating the completeness of data collection; Average Wait Times Report with appointment counts by physician by site and average durations; Provider Wait Times Report with office visit counts, Wait Time Category counts ( < 10 min, 10-20, 20-40, 40-60, and > 1 hour ) and average durations. Results: There was a correlation calculation to the patient satisfaction survey of .779, with long wait times more likely to be underreported by patients. Site and physician data were available for review at site Quality Committees. The data can be used by the site to improve processes, such as lab and infusion room scheduling. Time stamps are used to communicate patient readiness for next steps in the office visit. The time stamps provide objective data to discuss patient complaints with staff. Conclusions: Patient wait times are a valued measure of patient satisfaction and quality. Full utilization of the Day List and supporting technology allows us to objectively monitor and improve this aspect of patient care. Table 1: Sample Provider Report [Table: see text]