bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving cancer treatment handoffs: Wilmot Cancer Institute’s (WCI) ASCO Quality Training Program experience.
Authors: Dougherty David W. , Scarsella Elizabeth , Clarke Tammy , Alvino Elizabeth , Rich Lynn , Goonan Sean , Mietus Karen , Wade Nathaniel , Alongi Alex , Bobry Melanie , Guancial Elizabeth A. , Blaney Margaret , Amport Stephanie Buia , Pandya Chintan 
Published: April 2017

139 Background: Ineffective handoffs contribute to gaps in patient care and medication errors, jeopardizing patient safety and leading to poor quality of care. Ineffective handoffs accounted for 59% of reported medication events at WCI Infusion Center. The completion rate of WCI’s existing electronic medical record (EMR) based free text handoff note for patients treated with anti-cancer therapy on the same day as a clinic visit was 32%. The project aim is to create an effective EMR integrated treatment handoff tool and establish standard workflow processes to ensure optimal communication among WCI providers for improved patient safety and quality of care. Methods: We convened a multidisciplinary team to develop an efficient and safe treatment handoff tool. WCI nurses were surveyed to evaluate the baseline state of the handoff process. Tool development was performed over a series of phases, including creation of a project charter and aim statement, outlining current workflow process, identifying gaps and limitations in the process, identifying potential causes of ineffective hand-off and using a Pareto chart to prioritize them. Utilizing the Situation-Background-Assessment-Recommendation framework, an EMR-integrated handoff tool with standardized workflow process was developed, along with an educational plan for the tool. Results: 52% (N = 22/42) of nurses found the current handoff note to be ineffective at preventing errors and 48% (N = 20/42) identified incomplete or missing information as a significant factor for ineffective communication. Other barriers identified included poor note design, lack of standardization in workflow and variation in note use. During the 1 week implementation of the new handoff tool, the utilization rate was 100% (N = 32) with completion rate of 41% (13 of 32). Further data collection is ongoing and nursing perception of the new tool will be evaluated at 3 months. Conclusions: Multidisciplinary stakeholders’ guided development and implementation of an EMR-integrated treatment handoff tool to optimize the communication between cancer care providers during patient transition is associated with improvement in handoff tool utilization and communication.
Rate of use of NCCN “preferred” chemotherapy regimens for the treatment of HER2 positive breast cancer.
Authors: Gratias Eric J. , Rausa Margaret , Newcomer Lee N. , Andrews Kurt , Andrews Nick , Weininger Richard B. 
Published: April 2017

163 Background: The National Comprehensive Cancer Network (NCCN) Guidelines represent a well-established standard of care for the treatment of HER2+ breast cancer patients. eviCore healthcare is a licensee of NCCN that uses the NCCN guidelines to support its proprietary chemotherapy management program. All regimens assigned NCCN Category of Evidence 1, 2A, or 2B are adherent treatments in the eviCore program. NCCN recommends many systemic treatment options for HER2+ breast cancer, and a limited group is designated by NCCN as “preferred” based on superior efficacy and/or safety. This study evaluated the frequency of NCCN-preferred regimen use by practicing oncologists in HER2+ breast cancer patients. Methods: Chemotherapy authorizations for all HER2+ breast cancer patients with ≥ 1 injectable drug from 4/1/2015-9/30/2016 for multiple payers were included; > 90% of authorizations occurred in United HealthCare members. Cases with incomplete data were excluded. 3685 fully evaluable cases were stratified by stage, ER/PR status, and NCCN-preferred vs. NCCN-recommended status. The frequency of NCCN-preferred regimen selection was calculated for each subgroup. Results: There were 2883 HER2+/ER+ and/or PR+ cases and 802 HER2+/ER-/PR- cases. The highest frequency of NCCN-preferred regimen use occurred in neoadjuvant chemotherapy for patients with Stage III HER2+/ER+ and/or PR+ disease, where 88% of 289 patients used an NCCN-preferred regimen. Metastatic HER2+ patients had a markedly lower rate of NCCN-preferred regimen use at 62% of 557 cases. Only 48% of 1096 patients with Stage I/II HER2+/ER+ and/or PR+ disease received NCCN-preferred regimens. Conclusions: Patients receiving neoadjuvant chemotherapy for HER2+ breast cancer receive NCCN-preferred regimens at significantly higher rates than patients receiving adjuvant chemotherapy or metastatic treatment. Less than half of patients receiving adjuvant chemotherapy are receiving NCCN-preferred regimens. Further study is needed to determine the reasons for low preferred regimen use and ways to optimize preferred regimen use in HER2+ breast cancer.
Pregnancy screening prior to chemotherapy initiation: A retrospective review.
Authors: Rogers Brittany Kayla , Kolarich Andrew , Markham Merry Jennifer 
Published: April 2017

165 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) sets site standards to promote excellence in oncology care. One standard is screening appropriate female patients for pregnancy prior to chemotherapy. However, no formal guidelines exist regarding pregnancy screening protocols or timing of screening. We believe that women are inconsistently being screened for pregnancy prior to chemotherapy. Methods: A retrospective chart review was conducted using the UF Health (UFH) tumor registry and electronic health record (Epic) to identify women ages 18-55 who received chemotherapy or endocrine therapy by a medical oncologist between January 1, 2012 and December 31, 2014. Exclusions were prior hysterectomy or tubal ligation, known pregnancy, or treatment outside of UFH. The following data was collected: age, race, diagnosis date, cancer type, pregnancy screening test (urine or blood β-HCG) and date, specialty of ordering provider, name of chemotherapy or endocrine agent, and participation in interventional clinical trial. Results: Our search identified 501 potentially eligible women. Of these, 204 were excluded, 96% due to prior hysterectomy or tubal ligation. Of the remaining 297 eligible women, 103 (35%) received pregnancy testing prior to chemotherapy. Three screening tests were positive of the 103 pregnancy tests ordered. Follow up testing revealed 2 were true positives and 1 was a false positive. Of the 103 pregnancy tests, 23 (22%) were ordered by medical oncology, 51 (50%) were ordered by a surgery or anesthesia, and 16 (16%) were ordered by emergency medicine. 48% of the pregnancy tests were performed within 14 days prior to treatment start date. Conclusions: At our institution, pregnancy screening rates in women of childbearing potential were just 35%, and less than half of the women who were screened received pregnancy testing within 14 days of treatment start. Based on this data, a quality improvement project has been initiated in the outpatient medical oncology clinic and infusion center to improve pregnancy screening in this population. [Table: see text]
Implementation of surgeon-initiated Oncotype DX ordering among patients with breast cancer to reduce chemotherapy wait times.
Authors: Losk Katya , Freedman Rachel A. , Lin Nancy U. , Golshan Mehra , Lester Susan , Pochebit Stephen , Natsuhara Kelsey , Camuso Kristen , King Tari A. , Bunnell Craig A. 
Published: April 2017

166 Background: Oncotype DX testing in breast cancer is associated with delayed chemotherapy initiation, which may adversely impact clinical outcomes and patient satisfaction. We sought to reduce delays between surgery and adjuvant chemotherapy initiation among patients who undergo Oncotype DX testing by developing standard ordering criteria and modifying surgical oncology, medical oncology, and pathology workflows. Methods: We implemented ‘reflex’ Oncotype DX testing for any patient ≤ 65 with the following tumor characteristics: T1cN0 (grade 2-3), T2N0 (grade 1-2), or T1/T2N1 (grade 1-2). A new process was developed whereby once pathology review is complete surgeons communicate the results to medical oncologists in real-time and initiate requests for Oncotype DX when appropriate. Medical oncologists can order Oncotype for cases outside the criteria. A streamlined pathology system for receiving and processing Oncotype DX requests was also developed. We then examined 649 consecutive breast cancer patients who received postoperative Oncotype DX testing and measured time intervals between surgery date, Oncotype DX order date, Oncotype DX result received date, and chemotherapy initiation date (if applicable) before and after intervention implementation. Results: The interventions reduced the turnaround time (TAT) from surgery to Oncotype DX order and time to when the results were available by 7.7 days and 6.3 days, respectively. A 6.5 day decrease in the mean time from surgery to chemotherapy initiation was observed. The decrease in the standard deviation also suggests a reduction in process variation. Conclusions: Developing Oncotype DX testing criteria and implementing streamlined workflows among providers has led to a significant reduction in Oncotype DX ordering TAT and wait times to chemotherapy initiation. [Table: see text]
Improving hepatitis B screening prior to rituximab at a multispecialty urban hospital.
Authors: Nandagopal Lakshminarayanan , Paluri Ravi Kumar , Gleaton Barbara , De Idiaquez Diego Alonso , Nabell Lisle 
Published: April 2017

176 Background: Rituximab(R) is a novel anti-CD20 monoclonal antibody used in multiple hematologic and rheumatologic diseases. Patients who are hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb) positive are at risk for hepatitis-B reactivation with R-based treatments. Therefore, the VA’s medication use evaluation tracker recommends serological testing for HBsAg, HBsAb and HBcAb within 6 months prior to initiating R. We conducted a PDSA cycle to improve Hepatitis-B serological testing in patients receiving R at Birmingham VA medical center (BVAMC). Methods: For baseline evaluation, patients at BVAMC who were treated with R between 2004- march 2014 were retrospectively evaluated for HBV serology results 6 months prior to first treatment. Presence of all 4- HBsAg, HBsAb and HBcAb (IgM and total) was complete; absence of all 4 was ‘not done’ with remaining being incomplete. After conducting a RCA, 3 pharmacy-based interventions were implemented- 1) pharmacy education; 2) pharmacist autonomy to order hepatitis B serology eliminating physician dependence; 3) pharmacy reminders to health care providers to order HBV serology. We aimed to improve ‘complete’ screening rates to > 90% in the post-intervention period (april 2014-sep 2016). Results: In the pre-intervention group (n = 162), majority (81%) had hematologic indications and complete testing was performed in 38%, reminder being incomplete (13%) or not done (49%). Post-intervention (n = 86), majority (54%) had rheumatologic indications with complete testing in 71%, incomplete in 15% and not done in 14%. No Hepatitis B reactivations were identified in either study periods. Conclusions: Pre-intervention, ‘complete’ testing was performed in only one-third of patients and our intervention was effective in almost doubling screening rates. We also demonstrate increasing use of Rituximab in non-hematologic conditions and with second-generation anti-CD20 Ofatumumab and Obinutuzumab also requiring similar testing; our study could standardize Hep-B screening for these agents. A second PDSA cycle with a reflex ‘forcing-function’ EMR-based tool to decrease reliance on human factors is planned to meet the study goal of > 90%.
Clinical trials in Ontario’s quality-based funding model.
Authors: Forbes Leta , Evans William K. , Kais-Prial Thomas Eduard , Fung Ron , Lalonde Carlin , Hoskin Charlotte , Milgram Lisa , Cho Vanessa , Simanovski Vicky , Gavura Scott , Chan Kelvin K. 
Published: April 2017

186 Background: Clinical trials (CTs) are a key component of a quality cancer care system. When funding for systemic therapy services in Ontario transitioned in 2014 from a one-time payment for new cases to bundled payments for specific care activities (consultation, therapy, well follow-up, supportive care), a policy was developed to address public funding for systemic therapy in CTs. Methods: Treatment facilities receive funding from the Systemic Treatment-Quality Based Program (ST-QBP) for treatment with evidence-informed regimens inclusive of inexpensive drug, preparation and delivery costs. Under the new CT policy, randomized CTs with a standard of care comparator arm receive funding for all arms of the trial from the ST-QBP for older inexpensive drugs and all treatment administration costs at the band level for the disease type and stage. Non-randomized CTs are funded at the level of best supportive care or other appropriate band level. CT costs over and above the standard of care must be negotiated with industry sponsors. New and expensive drugs in CTs may be funded through separate provincial drug reimbursement programs if used according to publicly approved funding indications. Weekly joint reviews of new CT submissions by staff of the ST-QBP and drug reimbursement programs ensures timely communication to investigators concerning policy alignment and public funding and addresses potential concerns with regard to downstream access to expensive drugs. Results: As of January 29, 2016, 121 CT applications have been assessed (Phase 0 = 1, Phase I = 26, Phase II = 31, Phase III = 39, Phase IV = 1 and Multi-Phase = 23). Almost all CTs are aligned with the new policy and were assessed in a timely fashion. Assessments are posted on Cancer Care Ontario’s website within 1 week of review to allow all Ontario investigators access to this information. Conclusions: A clear CT funding policy and timely reviews support patient and investigator access to new and innovative therapies within an evidence-informed public funding model in Ontario, Canada. [Table: see text]
Providing consistent patient education across the continuum of cancer care.
Authors: Hoff Becky , Tonne Heidi 
Published: April 2017

187 Background: The need for consistent patient education across Cancer Care Services was identified while planning for the Fred and Pamela Buffett Cancer Center. Work began in November 2015 to validate if education provided by multiple providers in various settings was consistent and delivered a clear message to patients. A plan was developed to provide consistent education across the care continuum with the goal of enhancing patient experience, improving staff workflow and defining expectations for patient education. Methods: A survey to assess the current state of education was conducted. Participants in the survey included multidisciplinary team members from inpatient and ambulatory care settings. Five questions were asked about education consistency. Comments about the current and future state of education were encouraged. An audit of educational materials was completed and outdated resources eliminated. Results: 456 surveys were sent with 154 surveys completed (34% return rate). Five major themes emerged (documentation, role expectation, resource standardization/availability, handoff between departments and disciplines, and assessment of individual learning needs). The documentation in Electronic Medical Record was inconsistent and unable to easily assess learner progress. Role expectation was poorly defined with no consistent approach to education delivery. Resource standardization/availability had varying availability of education materials and staff unaware of resources. Handoff between departments and disciplines had inconsistent documentation and no established process to identify needs and barriers related to successful handoffs. Assessment of individual learning needs had unknown compliance in completing the Learning Questionnaire. A team was assembled to address the themes. A process map of patient education was created starting at the initial encounter through end of treatment. Staff was educated on their role, available resources, and documentation expectations. Conclusions: Conducting an evaluation of the patient education process allows for identification of improvement opportunities. This reduces patient confusion and increases trust. Patient satisfaction scores related to education have increased. This work enhanced the patient experience and helped prepare for a smooth transition of patient education initiatives into our new cancer center.
The impact of interruptions on physician workflow, productivity, and delivery of care.
Authors: Cheung Matthew C. , Trudeau Maureen E. , Mackay Helen , Naik Harsh , De Mendonca Ben , Eisen Andrea , Singh Simron 
Published: April 2017

201 Background: Physician interruptions during clinic and non-clinic hours can lead to medical errors, provider fatigue, prolonged clinic times, reduced academic output and poor job satisfaction. Repetitive interruptions can hamper the ability of physicians to deliver high quality patient-centered care. This study aims to evaluate the type, frequency, duration and self-reported physician response interruptions physicians experience in clinic. Methods: A work observation study was conducted at the Odette Cancer Centre, Sunnybrook Health Sciences Centre in Toronto, Canada. In-clinic data were collected from September 22 to October 6, 2016 using time-motion analyses by shadowing multiple oncologists in clinic. Interruption data were collected and categorized as follows: type of interruption, length of interruption, reason for interruption and role of interrupter. Physicians were asked to record and track themselves regarding interruptions they experienced during non-clinic hours using the same criteria. Results: Over a 2-week period, 5 medical oncology clinics (median 4 hours (hrs) per clinic), were observed and tracked. The clinic physicians averaged 22 interruptions per block, equating to 6 interruptions/hr (one interruption every 10 minutes (mins)). Over the 5 sessions, 112 data points were collected totaling over 1 hr 48 mins of interrupted time. Interruptions averaged 80 seconds (range of 4 to 517) in length with a positive skewed distribution. This calculates to approximately 30 mins of cumulative interrupted time per clinic session. Most interruptions were under 4 mins in length (4.1 at 95th percentile). The type of interruption varied but was most commonly in-person (67), email (24) and text message (10). Conclusions: Interruptions account for approximately 30 mins of physician time during a 4-hour clinic. An assessment of the type and frequency of requests proved highly variable, creating inconsistent ways messages are delivered to physicians. Interruptions potentially impact on patient care and disrupt the workflow of the clinic. These data provide future directions for exploring efficient clinic workflows and establishing standardized means of communicating with physicians during clinic hours.
Understanding the landscape and challenges of end-of-life measurement among comprehensive cancer centers.
Authors: Morse Denise , Pendleton Delinda ,   C4QI
Published: April 2017

207 Background: Quality at the end of life is vitally important to providing patient and family centered care, however the measurement of end of life care is challenging. Numerous metrics have been fully endorsed by the NQF, however benchmark data is difficult to obtain and clinicians question the usability and reliability of these existing measures. Methods: The Comprehensive Cancer Center Consortium for Quality Improvement (C4QI) convened an End of Life workgroup comprised of members from 21 cancer centers across the country. The first task of the workgroup was to collate existing end of life metrics that are in the public domain. Once the measures were collated, a survey was sent out to the membership for feedback on current utilization of measures and obtain baseline data where available. Data was pulled using the Vizient Clinical Database to look at the ability to pull end of life data within the database. The organizations were able to compare data on ICU Utilization, Chemotherapy, Length of Stay, and Cost. Results: The results of the C4QI End of Life survey showed that there challenges exist with interpretation and analysis. Even within ASCO QOPI, each center had their own issues with capturing the same population of cases and including/excluding the same criteria. Although we had received ASCO QOPI results from numerous centers, the comparison between the centers proved to be not as accurate of a comparison as desired. The Vizient data on inpatient mortalities and discharges to hospice showed differences among centers. The data led to additional discussions about the additional data needs especially as it relates to outpatient data capture both at each individual center as well as at other centers, and the need for more clarifying information about hospital makeup. Conclusions: The C4QI End of Life workgroup has agreed to focus on Advance Directive, Management of Pain at the End of Life, Palliative Care Referrals, and Hospice Enrollment. These 4 areas are the first step towards measuring advance care planning and quality at the end of life. The project shows the challenges of metric analysis, data sharing and benchmarking that collaborative groups face especially around potentially charged topics like End of Life.
Patient-reported outcomes for performance measurement: Multi-institution challenges.
Authors: Barysauskas Constance , McNiff Kristen K. , Flaherty Stephen , Morba Mary Ellen , Spinks Tracy E. , Fisher Terry , Jagels Barbara , Martin Neil E. 
Published: April 2017

211 Background: Patient-reported outcomes (PROs) are self-reported measures of a patient’s health or healthcare experience. PRO utilization is driven by the movement toward patient-centered care and emerging evidence which suggests patients (pts) more involved in their care experience better outcomes. The infrastructure to capture PROs is evolving and PROs are now used for performance measurement (PM). PRO-PMs assess the quality of healthcare for improvement and/or accountability; but implementation is challenging. Success of PRO-PM requires identification of pts, ongoing data collection and data aggregation across institutions. The Alliance of Dedicated Cancer Centers (ADCC) identified challenges of PRO use for PM. Methods: The validated tool, Expanded Prostate Cancer Index Composite, evaluating pt function and bother from treatment (trt), administered to new localized prostate pts at three independent cancer centers was retrospectively collected. Surveys administered before and after trt measured change from trt. Results: Institutions implementing PROs following local standards resulted in a high degree of variation. The aggregated data presented challenges in identifying eligible pt populations who received surveys before and after trt within a timeframe. We identified a pragmatic and meaningful pt population and survey implementation window. Pts were stratified by center and trt modality for analysis. Conclusions: The aggregation of dissimilar data sources led to the identification of institution implementation and data capture differences, however, the ADCC identified variation for PRO measure development. Clear guidance, policies and procedures are essential to ensure adequate homogeneity and reduced variability, to assure meaningful PM and reduce confounding by institution. [Table: see text]