bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measuring the impact of chemotherapy cost discussions between patients and providers at the time of prescribing.
Authors: Kelly Ronan Joseph , Forde Patrick M. , Bagheri Ashley , Ahn Jenny , Forastiere Arlene A. , Frick Kevin D. , Rosner Gary L. , Dy Sydney Morss , Smith Thomas J. 
Published: February 2017

257 Background: In 2007, the ASCO Cost of Care Task Force was established to deal with the soaring costs of cancer treatment in the United States. One of the key recommendations was that the cost of chemotherapy should be introduced into the patient-physician discussion from the outset. It is unknown if these discussions are occurring in academic Institutions and what if any is the impact on the doctor/patient relationship. Methods: The National Comprehensive Cancer Network (NCCN) Guidelines and the Eviti advisor platform were jointly used in an academic oncology center during the patient/doctor consultation to demonstrate treatment options to patients and display the costs at the time of prescribing to providers and patients alike. Questionnaires measured oncology providers attitudes to cost discussions and assessed physician satisfaction with the shared decision making process when costs are introduced into the patient/doctor relationship. Patients were interviewed before and after their doctor consultation to measure their satisfaction with the process using modifications of the shared decision making scale, satisfaction with decision scale and decisional conflict scale. Basic descriptive statistics were applied. Results: Only 5/18 oncologists (28%) reported feeling comfortable discussing costs with patients and just one (6%) admitted to regularly asking patients about financial difficulties. The majority (83%) of doctors reported that the NCCN guidelines should contain cost information. Seventy-one patients (42 females, 29 males) with metastatic breast (27%), lung (49%), and colorectal cancer (24%) have been interviewed. Interestingly, 70% of patients responded that no health care professional has ever discussed costs with them despite 57/71 (80%) rating this as very important information. The majority of patients (75%) had no negative feelings to hearing cost information. Only 4% admitted to developing significant negative feelings. Conclusions: In an era of rising co-pays, patients want cost of treatment discussions and these do not lead to negative feelings in the majority of patients. Additional training to prepare clinicians for how to discuss costs with their patients is needed.
Physician data review to reduce cost per case and ALOS.
Authors: Schreiner Susan , Franco Theresa 
Published: February 2017

268 Background: Reducing costs in health care is critical due to declining reimbursement. Physicians are often unaware of how their practices affect the cost of patient care and may have difficulty in making changes. The leadership of the Cancer Service Line believed a more targeted approach in sharing data would improve physician understanding and engagement to assist in greater standardization and cost reduction. Methods: An education and communication strategy was developed that involves the leadership of each specialty section of oncology. A dashboard was created with metrics such as clinic visits, surgical volume, cost per case, average length of stay, and net income. The data is presented in monthly, quarterly and annual time frames with trends to highlight progress and identify areas for improvement. Monthly meetings are conducted with key stakeholders to obtain critical feedback. Results: Consistent data has increased physician understanding of clinical businesses the business is doing and has prompted them to optimize clinical schedules and improve operational efficiencies. Outpatient and inpatient data regarding cost per case, ancillary costs, pharmaceutical usage, blood product utilization, and drug exchanges has driven practice changes. The ALOS is at almost an entire day below benchmarks and direct cost per case is at budgeted target. Standardization has occurred in the use of blood products and there has been an intentional shift of some interventions to the outpatient arena. Conclusions: The implementation of a robust education and communication strategy have resulted in active engagement and participation of physicians, significant practice changes in cancer care and heightened understanding of the relationship of practice to cost. A dashboard that trends relevant metrics shared at regular intervals with key providers impact the cost of cancer services without affecting the quality.
A systematic literature review of the impact of 5-HT3RA use on health care utilization in patients with chemotherapy-induced nausea and vomiting in the United States.
Authors: Broder Michael S. , Faria Claudio , Powers Annette , Sunderji Jehangeer , Cherepanov Dasha 
Published: February 2017

269 Background: Uncontrolled chemotherapy-induced nausea and vomiting (CINV) can lead to nutrient depletion, diminished function, disruption of chemotherapy, and increased costs. Standard antiemetic therapy includes 5-HT3RAs for CINV prophylaxis, with palonosetron recommended in National Comprehensive Cancer Network (NCCN), Multinational Association of Supportive Care in Cancer (MASCC), and ASCO guidelines as the preferred 5-HT3RA for CINV prophylaxis with MEC. There is evidence that using 5-HT3RAs can reduce costs but no comprehensive review of the evidence is available. Methods: We searched MEDLINE, National Institute for Health Research (NIHR), Centre for Reviews and Dissemination (CRD databases, 4 conferences (Academy of Managed Care Pharmacy, ASCO, International Society for Pharmacoeconomics and Outcomes Research, MASCC), and bibliographies of included articles. We queried Medical Subject Headings (MeSH) and key terms: “ondansetron,” “granisetron,” “palonosetron,” “dolasetron mesylate,” “costs,” “cost analysis,” and “economics.” Included records reported data on cost/utilization (rescue medication, outpatient/inpatient services) related to 5-HT3RA use for CINV in English, in human subjects, and published after 1997. Results: Of the 433 identified records, the 16 reporting utilization in the US were reviewed (excluded: 29 duplicates, 388 off-topic records). Studies varied significantly in designs, patients, 5-HT3RA regimens, and definition of outcomes. Twelve studies reported rescue medication use for CINV in patients using different 5-HT3RAs. In 5 studies, fewer patients treated with palonosetron required rescue medication versus ondansetron users (56% vs. 61%, 28% vs. 83%, 14% vs. 24%, 8% vs. 11%, 6% vs. 11%); 2 studies found palonosetron users had fewer outpatient services versus ondansetron users (5% vs. 10%, 8% vs. 10%). Four studies, with a variety of patients and outcomes, reported fewer patients treated with palonosetron versus ondansetron or other 5-HT3RAs used inpatient care (e.g., 0.2% vs. 0.4%, 16% vs. 23%, 7% vs. 10%, 0% vs. 5%), while 2 studies reported similar use (1% vs. 1%, 0% vs. 0%). Conclusions: CINV prophylaxis with palonosetron is generally associated with lower use of rescue medications, outpatient and inpatient services compared to ondansetron or other 5-HT3RAs. Use of palonosetron as a standard treatment may lead to reduced utilization of rescue medications and healthcare services for CINV and subsequent cost savings.
Risk factors for the development of chemotherapy-related hospitalization (CRH) in patients treated with palliative intent: Results of a 9-year nested case control study.
Authors: Kansagra Ankit J , Brooks Gabriel , Gao Jenny Hong , Jamali Layli , Kundi Meenakshi , Saini Neeraj , Stankiewicz Rosemary , Rao Sowmya R , Linden Erica Ann , Jacobson Joseph O. 
Published: February 2017

3 Background: Palliative chemotherapy is aimed at improving quality of life and increasing life expectancy, without curative intent. Toxicity during palliative treatment defeats the goal of care and increases healthcare cost. We describe the predictors of CRHs among cancer patients treated for palliative intent at a community cancer center. Methods: We conducted a nested case-control study of adult cancer patients who received chemotherapy from Jan 03 to Dec 11. Utilizing a pharmacy database we identified patients who had received chemotherapy for palliative intent. For quality measures cancer center prospectively collects data on all the patients who developed CRH, which was used to identify cases. Hospitalizations were classified as CRH, disease-related or unrelated by a multidisciplinary panel. We frequency matched 2 controls to per case on lines of their chemotherapy treatment (3 groups). We obtained odds ratios (OR) and 95% confidence intervals (CI) from a multivariable logistic regression model on this set of 199 cases and 398 controls to identify predictors of CRH. A two-sided p-value of 0.05 was used for all measures of statistical significance. Results: During the selected period 6,850 patients received chemotherapy, 2,559 (37.3%) for palliative intent. 230 (9%) of 2,559 developed CRH. 76.5 % of CRH happened during the first 3 cycles of chemotherapy, and the mean length of stay was 5 days. Significant predictors on multivariable regression were ECOG score (p = .03), Charlson score (p= .0018), cancer site (p <.006,) abnormal creatinine (p <.0001) and low albumin (p < .007). Conclusions: The results of this mature study demonstrate that patients treated with palliative chemotherapy have a substantial risk of severe hospital-requiring toxicity resulting in morbidity and cost. The finding that risk of severe toxicity is increased among patients with poor PS, multiple comorbidities and renal insufficiency suggests that some events may be avoidable. Furthermore, identified risk factors will enable the development and testing of a predictive model which could be used to identify patients at high risk of CRH prior treatment initiation.
Implementing an oncology-specific health care IT portal to enhance patient-provider communication.
Authors: Patt Debra A. , Trageser Jennifer , Howard Jeffrey A. , Rush Max , Heiman Cara , Yalamanchili Rajesh , Lodder Daniel , Neiman Julie , Khang Hk , Langer Lucy R. , Schwartz Rowena , Ahmad Asif 
Published: February 2017

31 Background: Our large network of oncology practices (PRs) launched a health IT (HIT) patient portal (PP) to improve patient (PT) access to clinical information (CI) and serve as a platform to enhance PR-to-PT communication (C). Methods: A team of HIT specialists and oncologists engaged in development of the PP to develop a platform to facilitate PR-to-PT C, satisfy meaningful use (MU) requirements, and have brand identification (ID) for PRs. Workflow planning for implementation was conducted including ID and education of key participants at PRs. Educational signage was posted at PRs during initiation partnered with information at check-in at clinic visits to inform PTs about PP benefits and registration steps. After consent was obtained, pts were invited by email to the PP and could access their PP and view and download their secure CI. A review of support calls from both PR personnel and pts highlighted opportunities for enhanced PP engagement. Enrollment (E) was captured monthly. Results: From April 2012 to June 2013 more than 34,000 pts have enrolled in the PP across over 47 PRs (Table). In addition, inclusion of the PR brand and removing extraneous data capture during E are critical to success. Comparing E data from April 2012 to April 2013 after increased PR brand ID and reduction of pt validation changes were implemented, there was an increase of 13% of opened Is and 22% increase in Es. Conclusions: By engaging a development team, and strategically planning content dissemination and education around initiation, implementation of the PP was widely utilized throughout the PRs. By monitoring adoption rates and capturing the PT feedback, incremental enhancements can positively affect PT engagement with PRs. This functional mechanism can now serve as a platform to facilitate C between PRs and PTs, fulfill MU requirements, and plan future dissemination of educational content. [Table: see text]
Bridging to survivorship in breast cancer: How BMI weighs in.
Authors: Espirito Janet L. , Turnwald Brian , Harrell Robyn K. , Bhowmik Debajyoti , Denduluri Neelima , Brooks Barry Don , Hoverman J. Russell , Patt Debra A. 
Published: February 2017

32 Background: Obesity and depression complicate survivorship in early stage breast cancer (BC) by having a direct impact on survival and morbidity among patients (pts) who complete treatment (tx). The prevalence of obesity after BC tx in the community and concordance with BC tx type is poorly described, but important as we characterize risks of tx and optimize goals for survivorship care planning. Methods: We queried the electronic health record (EHR), iKnowMed, from a large network of community oncology practices for pts diagnosed with stage I-III BC from 2007-2010 with at least 5 office visits and follow up through 11-2012 for our retrospective study. We excluded pts who developed metastatic disease or died. We stratified pts by chemotherapy (CT) utilization (yes/no), hormone receptor (HR) status, age, and documented body mass index (BMI) at first office visit and annually. We evaluated changes in BMI characteristics by tx cohort. Results: We identified 8,506 pts with a documented BMI at first office visit and 1, 2, and 3 years (yrs) thereafter. 4,369 (51% of the total) pts received adjuvant CT and 4,137 (49%) did not. 6,897 pts (81%) were HR positive. Baseline BMI between tx cohorts were similar, though the prevalence of overweight (31%) and overweight or obese (68%) is high. Percent change of BMI at 3 yrs varied significantly between T cohorts (p<0.01) with greater rise among the cohorts who received CT in comparison to those who did not. Pts receiving CT were 46% more likely to have a 5 point or more increase in BMI at 3 yrs compared to pts that did not receive CT (OR 1.46, CI[1.08-1.96]). A stronger association for BMI increase of at least 0.5 points at 3 yrs (OR 1.53, CI [1.4-1.7]) was also observed amongst pts who received CT compared to those that did not. HR positive pts were less likely than HR negative or unknown pts to increase their BMI by at least 0.5 points (OR 0.84, p<0.01), but there was no difference at detecting a difference of 5 points in BMI (OR 0.88, p=0.49). Conclusions: With 3 yrs of follow up, overweight and obese status is remarkably common among BC survivors in the community and appears to be more prevalent after CT tx. Determinants of obesity require further study and point to necessary intervention to improve the health of early stage BC pts.
Bridging to survivorship in breast cancer: Learning how treatment impacts mental health among early-stage breast cancer survivors.
Authors: Patt Debra A. , Espirito Janet L. , Harrell Robyn K. , Turnwald Brian , Bhowmik Debajyoti , Brooks Barry Don , Denduluri Neelima , Hoverman J. Russell 
Published: February 2017

33 Background: Depression (D) and anxiety (A) complicate survivorship in breast cancer (BC) patients (pts). The prevalence of D and A after BC treatment (Tx) in the community and concordance with BC Tx type is poorly described, but vitally important to characterize risks of Tx and optimize support for BC pts and goals for survivorship care planning. Methods: We queried the electronic health record (EHR), iKnowMed, from a a large network of community oncology practices for pts treated with stage I-III breast cancer from 2007-2010 with at least 5 visits and follow up through 2012 for our retrospective study. We excluded pts who developed metastatic disease or died. We stratified pts by chemotherapy (CT) utilization (yes/no),hormone receptor (HR) status, age, and documented body mass index (BMI) at diagnosis, and post diagnosis development of D (y/n), A (y/n) or utilization of venlafaxine (E) like antidepressants (Ads), non-E like Ads or anti-A medications within the study period. Time to onset of A or D was analyzed using Cox proportional hazard methodology. Results: We identified 8,506 patients with a documented BMI at 1, 2, and 3 years (yrs) post diagnosis. 4,369 (51%) of patients received adjuvant CT and 4,137 (49%) did not. Baseline characteristics were similar between tx groups, and active D or A was low at the time of dx, but as a whole rose to 41% during the study period. Pts with pre-existing D or A at the time of diagnosis were excluded. CT increases the risk of D or A (HR: 1.23, CI: 1.15-1.33). HR+ status also increases the risk of D or A (HR: 1.21, CI:1.11-1.32). Age conveyed a small diminished risk of D or A (HR: 0.98, CI: 0.98-0.99) while baseline BMI conveyed a small increased risk (HR: 1.02, CI 1.01-1.3). When excluding E like compounds that are often used to treat hot flashes in BC pts, CT was still found to have an increased risk of D or A (HR: 1.28, CI: 1.18-1.39), and HR+ was still associated with higher risk of D or A as well (HR: 1.11, CI: 1.01-1.22). Conclusions: Mental health disorders such as D and A are common among BC survivors, and more prevalent among BC survivors who received CT and have HR+ disease. This warrants further investigation on how to evaluate and support the mental health needs of BC survivors.
Design, implementation, and assessment of a metrics management system for quality improvement studies.
Authors: Samedy Patrick 
Published: February 2017

34 Background: Research and quality improvement studies often involve an extensive amount of manual review of medical records. The effective management of this process is critical to the consistent, accurate, and cost effective collection and timely dissemination of quality data. Methods: The purpose of this paper is to introduce “OpenQA”, a data management tool designed specifically to help organize, track, and communicate data related to quality improvement studies. OpenQA is designed with ease of chart abstraction, efficiency of data collection, and data transparency as a goal, while providing reporting that support a range of activities related to data management tasks common to hospital quality management departments. The basic method behind OpenQA is to: (1) Provide a centralized online repository for measure related metadata; (2) automatically identify retrospective and prospective encounters that meet specified study inclusion/exclusion criteria; (3) extract key details from structured and unstructured data sources and then combine them to help quality auditors make compliance decisions; (4) provide a workflow engine that supports work lists, alerting and a feedback mechanism for metric stakeholders; (5) provide audit tracking to enable measurability of data collection efforts. Results: Favorable effects were realized post implementation across all measures of performance despite an increase in case volume. Results indicate a decrease in median audit turnaround time, defined as the time between the patient encounter and a decision is made by the auditor, by 23 days (85%). Results also indicate a decrease in the audit reporting turnaround time, defined as the time between the patient encounter and the compliance decision is made and reported. Both reductions were significant at a p value of < 0.05. Conclusions: We suggest that a tool designed to help streamline and standardize the quality improvement data collection process may offer the advantage of minimizing the resource utilization associated with data collection while improving data integrity and shortening the feedback loop.
Prevalence and predictors of online patient access to electronic medical records among patients with cancer.
Authors: Laccetti Andrew L , Yan Jingsheng , Cai Jennifer , Gates Samantha , Xie Yang , Lee Simon Craddock , Gerber David E. 
Published: February 2017

35 Background: Although the impact of patient access to health records and providers has not been well studied in cancer populations, these applications are now widely employed at cancer centers nationwide. Understanding implications of this practice in cancer patients is critical as patient-reported symptoms may be more likely to represent medical emergencies and test results may be more likely to represent major clinical developments. Methods: Retrospective analysis of enrollment in and use of MyChart, an internet-based patient portal for the EPIC electronic medical record, among patients seen at the Harold C. Simmons Cancer Center at UT Southwestern Medical Center. Predictors of MyChart use were analyzed through univariate and multivariate regression models. Results: A total of 6,495 patients enrolled in MyChart (2006-2012). Mean age was 60 ± 13 years, and 67% were female. The number of patients enrolling per year increased more than five-fold - 181 in 2006 to 1,146 in 2012. The total number of MyChart log-ins was 707,746. Per patient, median total log-ins was 57 (range 1-10,347). In a multivariate model, increased MyChart use was associated with male gender (p=0.01) and with cancer type (p<0.001), with highest rates among patients with genitourinary and upper aerodigestive malignancies. The most common MyChart activities were review of laboratory and radiology results (35%), communicating with providers (34%) [including messaging (29%) and medical advice request (5%)], and appointment scheduling/canceling (18%). Eighty-nine percent of log-ins occurred Monday-Friday. Login-times were 8a-5p (72%), 5p-11p (17%), and 11p-8a (11%). Approximately 32% of messaging (40% of medical advice requests) occurred outside clinic hours. Conclusions: Patient use of an internet-based patient health portal at an NCI-designated cancer center increased dramatically in recent years. The most common activities were viewing of test results and messaging with providers. A substantial proportion of messaging, particularly advice requests, occurred outside clinic hours. Further study of this technology is needed to understand its impact on patient safety, patient/provider satisfaction, and quality of care.