bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of the effectiveness of a prechemotherapy teaching session: A Brown University Oncology Group study.
Authors: Connell Nathan , Mega Anthony E. , Castillo Jorge J. , Fenton Mary Anne , Bartley Carolyn , Kaplan Anne , Murphy Benjamin , Iannuccilli Jenna , Stobie Lindsey , Touloumtzis Currie , Schumacher Andrew , Korber Susan , Faricy-Anderson Katherine E. , Bakalarski Pamela , Sikov William M. , Safran Howard , Thomas Anthony George , Isdale Debora , Rosati Kayla 
Published: February 2017

260 Background: Pre-chemotherapy teaching sessions, often coordinated by nursing personnel, are an opportunity to educate patients on treatment side effects, schedule, medications for toxicities such as nausea, and how to contact the oncology team if adverse events develop. Our institution provides a structured 60-minute nurse-coordinated pre-chemotherapy teaching session. The aims of this study were to evaluate whether pre-chemotherapy teaching sessions improve patient knowledge, preparedness, and anxiety in relation to chemotherapy. Methods: Patients were offered the opportunity to participate in the study after their medical oncologist had reviewed their treatment regimen. After informed consent was obtained, participants were administered a 10-question survey assessing knowledge of treatment adverse effects, treatment schedule, management of complications, accessing their medical team, and patient anxiety. Subjects then participated in a pre-chemotherapy teaching session with an oncology nurse. The survey was readministered when patients returned on day 1, cycle 1 of treatment and on day 1, cycle 2. The questionnaire used a 1 to 4 rating scale (1=no knowledge, 2= minimally informed, 3= reasonably informed, 4= well informed). A pre-defined mean change of 1 on the rating scale was considered to be clinically significant. Paired one-sided t-tests were performed to evaluate the mean change in groups between each of the three surveys. p values <0.05 were considered statistically significant. Results: At the time of analysis, 78 patients had completed a pre-chemotherapy teaching session and all three surveys. After participating in a teaching session, there was an increase in patient’s perceived knowledge of side effects (mean score 2.3 vs. 3.5, p<0.001), knowledge of the treatment schedule (mean score 2.4 vs. 3.5, p<0.001) and medications to prevent nausea (mean score of 1.4 vs. 3.1, p <0.001). There was also a statistically significant reduction in patient anxiety in relation to treatment, p< 0.001. Conclusions: These results show that a nurse-coordinated, pre-chemotherapy teaching session increases patient knowledge and reduces anxiety regarding their upcoming treatment.
A self-assessment tool for safety and quality improvement in radiotherapy.
Authors: Pawlicki Todd , Dunscombe Peter , Ford Eric 
Published: February 2017

263 Background: The radiation treatment community has traditionally had a strong focus on the safety and quality of the care provided to cancer patients. Recent well publicized events in the United States and around the world have served to further sharpen this focus and have resulted in the generation of many reports offering advice and recommendations on how we could do better. While advice is plentiful, practical tools for the on-going improvement of safety and quality in radiotherapy are generally lacking. The online Safety Profile Self-Assessment Tool, described here, is being developed to fill this gap. Methods: The tool was built principally on three foundations: The Agency for Healthcare Research and Quality’s (AHRQ) validated survey tools, an analysis of recommendations in seven recent authoritative documents and the AAPM’s Work Group on the Prevention of Errors “Consensus recommendations for incident learning database structures in radiation oncology”. A core group developed a demonstration version of the tool. Both the content and functionality of this version were extensively discussed and further developed at a Workshop including representatives of ASRT, ASTRO, AAMD and SROA. Iterative refinement of the tool took place after the Workshop. Results: The tool is divided into four major sections: (1) Institutional Culture, (2) Quality Management, (3) Managing Change and Innovation, and (4) Clinical Performance. The fourth section, Clinical Performance, is further subdivided into the major steps in the radiotherapy process. The 90 safety/quality indicators take the form of statements with which the assessor identifies the degree of compliance on a five point Likert scale. An example of a Safety/Quality indicator isClinical staff submits reports of errors and near-misses.The assessor responds to this statement on a scale ranging from “Always” to “Never”. The online tool includes a Safety/Quality Improvement log to facilitate tracking the implementation of remedial actions taken in response to identified system weaknesses. Conclusions: An online tool to facilitate Safety/Quality improvement in Radiotherapy is at an advanced stage of development. The tool will be released for general use in the fall of 2012 and fully evaluated thereafter.
Team training in adult oncology.
Authors: Gross Anne , Mann Susan , Kalfin Michael , Lane Sharon , Weingart Saul , Bunnell Craig A. 
Published: February 2017

27 Background: In outpatient oncology, clinicians working in various locations and at different times, rely on each other for information to coordinate and manage care. Increasingly complex treatment algorithms magnify risk for adverse events precipitated by failures of communication/coordination. We implemented team training in 16 adult practices across five campuses (community and academic) to reduce errors and increase efficiency/quality. Methods: 1,000+ MDs, NPs, PAs, RNs, pharmacists, and support staff were trained in teamwork concepts. Interventions and methods included baseline data collection on key clinical processes, (e.g. same-day chemotherapy changes not communicated to treating RN); observations and interviews with teams; “train-the-trainer” sessions; identification of “pain points”; interdisciplinary "process meetings" to develop agreements, tools and systems changes to support better communication/efficiency; trained all staff; collected data six months post-training. Results: Despite infrequency of noncommunicated same-day changes in chemotherapy at baseline (~2%), an improvement trend was seen (chi-square p=0.068). Incidence of missing infusion orders, not associated with an MD visit, decreased significantly. Providers reported fewer unnecessary pages. Nurses reported quicker, more reliable responses to pages sent. Staff reported improved practice efficiencies and safer, respectful work environments. Qualitative interviews elicited patient perceptions of communication, teamwork, and care coordination. Patients’ quantitative perceptions of teamwork improved significantly. Conclusions: Team training improved communication, task coordination, interactions with team members, staff perceptions of efficiency, quality, and safety and patient perception of teamwork in the outpatient practices of a comprehensive cancer center. [Table: see text]
Assessing quality in a rural oncology program using the Quality Oncology Practice Initiative (QOPI).
Authors: Loui William S. , Auerbach Bonnie , Bince Jeanette , Brazzel Sandra , Thomas William 
Published: February 2017

275 Background: Molokai General Hospital (MGH) is a critical access hospital for 7,400 people on the isolated island of Molokai. It is a small 14 bed medical center that started an outpatient oncology program six years ago. Over this period, 213 patients received care through an innovative telemedicine program partnership with the Queens Medical Center in Honolulu, Hawaii. Methods: Study design was a retrospective chart review. Results: The most common types of cancers seen were breast cancer 57 (26.7%), lung cancer 29 (13.6%), colon cancer 26 (12.2%), prostate cancer 29 (13.6%), lymphoma 8 (3.7%), and liver cancer 3 (1.4%). Cancer patients were almost 80 % minorities; over 55% were native Hawaiians or part Hawaiian. The percentage of Caucasians, Hispanic, and African American were lower than the national averages. Hawaiian 118 (55.3%), Caucasian 43 (20.8%), Filipino 30 (14%), Japanese 17 (7.9%), African American 2 (0.9%), Other Pacific Islanders 2 (0.9%), Hispanic 1 (0.4%) Using national and local benchmarks from QOPI, areas of excellence and deficiency were identified. In 29% of the core measures, MGH did a better job than the urban comparison in Honolulu, Hawaii. For breast and colon cancer, the quality was better than the national QOPI aggregate. Similarly, the symptom care was better than national average. A survivorship program was initiated 2 years ago and treatment summaries were beginning to be sent. Since its start, 45 of the total 213 (21.1%) patients have been enrolled in the Survivorship program. Conclusions: The QOPI program helped review a small rural program which lacks staff and resources for a full time Quality Improvement program. This may be a model for other small programs to check for quality of care.
Timeliness of adjuvant chemotherapy (AT) for stage III adenocarcinoma of colon (CC): A measure of quality of care.
Authors: Yu Steven , Shabihkhani Maryam , Sadeghi Sarmad , Lenz Heinz-Josef , Senagore Anthony , Barzi Afsaneh 
Published: February 2017

282 Background: In the past three decades multiple clinical trials have proven the benefit of AT for CC, establishing combination chemotherapy after recovery from surgery as a quality measure in stage III CC. The majority of clinical trials require enrollment for AT within eight weeks from surgery nonetheless there is no established standard time for delivery of AT. Timeliness of service is defined as one of the domains of quality care by Institute of Medicine. We explore the timing of AT as a quality measure in patients (pts) with CC. Methods: We conducted a retrospective analysis of pts with CC who underwent surgery in Los Angeles County Hospital between January 2005 through December of 2009, with at least six months of follow up after surgery. Pt, disease and treatment characteristics were recorded. Disease free survival (DFS) was measured as the time from surgery to the last follow up or recurrence. Results: 52 pts, median age 58 years (28 – 86), 62% female, 65% Hispanics, 21% Asian, 6% black and 6% white, with CC were included all of whom received adjuvant FOLFOX. 24 pts had right and 26 left-sided cancers. Median start day for AT was 60 days after surgery (12-145 days), with 60% waiting more than 8 and 19% more than 12 weeks. 4 pts received 6, 1 pt 10, 2 pts 11 and 45 pts 12 cycles of therapy. 17 pts had recurrence, 3 local and 14 systemic. Median DFS was 25.3 month (range 8-70). In univariable analysis only age was a predictor of recurrence (HR 0.96 95% CI 0.92-0.99). Time from surgery to adjuvant chemotherapy was not a predictor of recurrence (systemic, local and combined), or DFS. Conclusions: In several meta-analyses time form surgery to AT is identified as an independent risk factor for death from colon cancer. In this study there was no association between time from surgery to AT and DFS. Delivery of AT depends on several factors including recovery from surgery, medical oncology visit, placement of a central line, and initiation of the treatment. Quality measures to assess each of these processes can improve the adherence to available data and improve enrollment on clinical trials. The major limitation of our study is the limited sample size and lack of power to detect a small effect.
Improving cancer care by linking community cancer center physicians to disease site-specific experts.
Authors: Hardenbergh Patricia H. 
Published: February 2017

287 Background: The goal of this project is to improve quality of cancer care across the United States by connecting community cancer center radiation oncologists with highly specialized, disease site-specific radiation oncologists through the use of online technology. Methods: We have developed a website named chartrounds.com which allows community radiation oncologists to interact online with disease specialists and their peers on a scheduled basis in order to present and review radiation oncology treatment plans and cases in real time. Disease sites currently include breast, head and neck, gastrointestinal, gynecologic, prostate, central nervous systems, pediatric, lymphoma and lung cancers. At the conclusion of each session, participants are asked to complete a feedback questionnaire requesting feedback on quality and relevance of the session and the manner in which it might result in practice changes. Results: 650 community radiation oncology physician members from 49 states and 19 countries have enrolled online. In the initial 18-month period (12/2010-6/2012), 23 disease specialists have lead 188 chart rounds sessions with an average attendance ratio of 10 community physician members to 1 disease specialist. On a 5 point Likert scale with 5 representing the greatest impact possible, the mean response to feedback questions is as follows: session quality: 4.7, time used effectively: 4.6, discussions relevant to daily practice: 4.7, session is likely to result in a change in practice: 4.0.More specifically, members reported that they would make the following changes in their practice: change in clinical management of the radiation patient: 35%, change in the selection of patients for radiation: 17%, change in radiation fields: 15%, change in radiation prescription dose: 9%. Conclusions: Chartrounds.com appears to be impacting radiation oncology practice resulting in changes in management and treatment of patients in community cancer centers. Future directions of this project are aimed at demonstrating how these changes could result in significant improvements in cancer care across the United States. This work is funded by the Improving Cancer Care Grant of the ASCO Conquer Cancer Foundation.
Use of electronic medical records on cancer screening rates: The proactive office encounter.
Authors: Schottinger Joanne E. , Andrews Kristen L. , Lindsay Gail X. , Kanter Michael H. 
Published: February 2017

289 Background: The Southern California Permanente Medical Group cares for a diverse population of 3.5 million members. An electronic medical record supports the care of patients at each outpatient and inpatient encounter. In the US, only about 55% of Americans receive recommended preventive care services. Methods: The Proactive Office Encounter (POE) was developed to proactively address care gaps in preventive or chronic care needs at the point of service with every visit to either primary or specialty care. Prior to a visit, the staff identify missing labs or screening procedures and provides the patient with pre-visit instructions. With a standardized workflow and checklist used during any office visit, care gaps are identified from decision support tools in the electronic record and office staff pend necessary orders to the physician. The room is prepared for any procedures necessary (Pap), iFOBT kits are made ready for use if indicated, and on exiting, the patient receives an after visit summary that includes any necessary follow up instructions. Successful Completion Opportunity Reports are produced for every department to measure the improvement of closing care gaps. A small financial incentive is applied for specialists for these successful comp-letions (P4P). Back office work flow reports measure the elements of POE at the individual staff level. Performance on screening rates is reported bimonthly for feedback. Results: Within two years of implementation, pre and post POE cancer screening rates increased from 85.6 to 88.7 (3.1%) for breast cancer; 82.0 to 86.6 (4.6%) for cervical cancer; and 52.5 to 69.7 (17.4%) for colorectal cancer. Rates for advising smokers to quit smoking increased from 53 to 68 (15%). Conclusions: Use of evidence-based logic integrated in an electronic medical record combined with standard work flows deployed in primary and specialty care reliably ensures that patients receive needed services at every visit. This contributed to sharp rises in preventive care quality measures. Care shifts from being reactive to team-based and proactive and is no longer dependent on a physician remembering all the needed elements of care.
Use of an electronic health record to improve follow-up of elevated lab results: The PSA safety net.
Authors: Danforth Kim N. , Jacobsen Steven J. , Miyaguchi Lauren N. , Zhou Hui , Slezak Jeff M. , Loo Ronald K. 
Published: February 2017

292 Background: Follow-up of laboratory results is challenging in outpatient care, and research indicates an electronic health record (EHR) alone is insufficient to ensure appropriate follow-up of abnormal results. Methods: In April 2006, Kaiser Permanente Southern California implemented a Prostate-Specific Antigen (PSA) Safety Net to detect men with elevated serum PSA levels who had not yet received follow-up care at 6 months post-testing. The PSA Safety Net scanned the EHR to identify men age 45-79 with elevated PSA values. Men were then excluded if they had a prior prostate cancer diagnosis or evidence of follow-up care within 6 months of the PSA test, defined as any of the following: a subsequent visit with a urologist or oncologist, normal PSA value, biopsy, or prostate cancer diagnosis. In June 2009, the criterion for follow-up care was reduced from 6 to 3 months. The electronic Safety Net tool was refreshed daily, stored key data (e.g., contact information), and recorded actions of care managers (e.g., expedited appointment scheduled). We evaluated how many men were identified through the PSA Safety Net and whether they were systematically different from men followed through routine care. Results: From 4/2006-12/2010, 45,762 men had an elevated serum PSA level. Twenty percent (n=9,373) were identified through the PSA Safety Net. Of 7,729 prostate cancers diagnosed, 9.6% (n=739) were found through the PSA Safety Net. Age, race/ethnicity, and language preference was similar among men followed through the Safety Net vs. routine care. Men followed through the PSA Safety Net were less likely to be enrolled in kp.org (46% vs. 54% respectively, p<0.001), which provides online access to lab results. Median PSA levels were slightly lower among those followed through the PSA Safety Net. Men in the Safety Net also were less likely to be diagnosed with Stage IV cancers than men followed via routine care (2.8% vs. 5.5%, p=0.002), although stage was similar overall. Conclusions: Within a health system using an advanced EHR, a substantial number of men with elevated PSA levels were identified and managed through a PSA Safety Net. These men were largely similar to those followed through routine care, although tended toward lower risk.
Impact of computerized provider order entry on medication errors in outpatient chemotherapy administration.
Authors: Bazhenova Lyudmila , DeMoor Patricia A. 
Published: February 2017

295 Background: Computerized provider order entry (CPOE) reduces medication errors (ME) in ambulatory and hospital settings. We conducted a study to assess the effect of CPOE on ME in an outpatient NCI designated infusion center (IC). Methods: Both actual and prevented ME were prospectively reported by clinical staff as part of IC Standard Operating Procedure using the electronic Quality Variance Reporting (eQVR, Incident Reporting 2.0, University of California) system. Reported ME from 10/2007 to 03/2011 were reviewed by 2 investigators and classified into categories by consensus: wrong medication given (WM), medication missed (MM), wrong timing/rate (T/R), wrong dose (WD), unmet chemotherapy parameters (UP) and other (O). Classifications were further categorized by preventable or facilitated by CPOE. We compared ME 18 mo. pre and post implementation. The 6 month go live period was reviewed separately to examine ME related to a learning curve (LC). Results: 40,366 patients were seen pre-implementation, 47,460 post, and 14,343 during go live. The total ME per pt was similar pre and post (see table). There were dramatic rate differences in WM and MM, but no effect on T/R, WD, UP. In the pre period 66% of ME were felt preventable by CPOE. In turn 35% of ME were facilitated by CPOE. Preventability rates differed between categories. During go live 100% of CPOE facilitated ME were related to user and designer LC. Post implementation 58% of CPOE facilitated ME were still accounted by LC with the rest felt related to the complexity of CPOE. Conclusions: ME are rare in our outpatient IC. CPOE did not change the total number of ME but significantly decreased the rate of WM. Complexities of CPOE resulted in increased MM. LC related errors still occur 24 mo. after implementation of CPOE and require constant monitoring and education. CPOE increased the rate of serious ME felt due to the change in workflow and adding an extra layer of complexity. Human errors cannot be fixed with CPOE and generally encompassed the ME in T/R, WD, and UP classifications [Table: see text]
Medication therapy management (MTM) in a multidisciplinary supportive oncology clinic.
Authors: Mancini Robert , Clifford Kathleen , Brown Michele , Watts Lori , Zuckerman Dan Sayam , Levin Rhone , Robenstein Valerie 
Published: February 2017

30 Background: Patients with advanced cancer experience significant symptom burden and psychosocial distress from the onset of their diagnosis and throughout treatment shifting the paradigm of supportive care. In addition, most cancer patients have multiple co-morbidities and are at high risk of poly-pharmacy. One in three ambulatory cancer patients are at risk of drug-drug interactions. Methods: In June 2010, a multidisciplinary supportive oncology clinic, modeled after the Massachusetts General Hospital article by Temel et al., was started and staffed by a pharmacist, a nurse, a social worker and a dietitian and lead by a nurse practitioner. A chart audit was conducted for all patients seen in the clinic between June 2010 and March 2012. Pharmacy assessment entries were evaluated for diagnosis, medication issues and total time spent with patients. Duplicate therapy was defined as an unnecessary duplication in therapy for a single symptom and/or two medications in the same class. Drug-Interactions were assessed utilizing Micromedex 2.0 Drug-Interaction Checker and Lexicomp Lexi-Interact Online drug-interaction analysis program. All major kinetic interactions were recorded and pharmacodynamic interactions were recorded if they required intervention. Results: From June 2010 to May 2012, 153 patients were seen in the clinic. The most common diagnoses were pancreatic, lung, breast and head and neck. Use of a standardized pharmacy assessment identified duplicate therapies in 45.1% of patients, drug-drug interactions in 35.3%, side-effects in 83%, lack of efficacy in 88.9% and untreated conditions 68.6%. The pharmacists spent an average of 44.1 minutes (range 15-90 min) with patients. Conclusions: Pharmacist-initiated MTM identifies a higher rate of poly-pharmacy, drug-drug interactions and side effects than found in literature. Identification allows for referral to other disciplines within the clinic for work-up. Gastrointestinal related issues were referred to a dietitian, psychosocial issues including adherence issues to a social worker and medication related issues to the nurse practitioner for follow-up. Initial identification of these issues has allowed for more long-term follow-up in these patients.