bluuebunny/crossref_metadata_2025_split huggingface dataset:
A clinical care pathway to improve the acute care of patients with glioma.
Authors: Riblet Natalie , Snide Jennifer , Schlosser Evelyn , Nalepinski David , Jalowiec Lanelle , Ronan Lara Kunschner , Mason Linda , Kennedy Nancy , Powers Sabrina , Cooney Tobi , Thorley Katherine , Fadul Camilo E. 
Published: February 2017

217 Background: Gliomas account for nearly 80% of primary malignant brain tumors and are associated with poor survival. Developing clinical care pathways to ensure that patients receive coordinated, comprehensive and timely care may result in improved outcomes and patient satisfaction. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and met weekly and then monthly from Feb 2013 – April 2014. Twenty best practice measures were identified from the literature. Using a Plan-Do-Study-Act framework, the team brainstormed and implemented various improvement interventions between Oct 2013 and Feb 2014. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing reporting. Results: Retrospective data was available for 12 best practice measures; 6 of which could be abstracted from electronic medical records. Eight measures were not part of the current system of care. The baseline population consisted of 98 patients with gliomas. Review of their records suggested wide variation in performance, with compliance ranging from 30% to 100%. Unanticipated opportunities for improvement included a high proportion of outpatient falls (7%) and urinary tract infections (10%). The team hypothesized that lack of standardization in the current process may contribute to less-than-ideal performance. After implementing improvement interventions, the records of 19 consecutive patients with glioma were reviewed. The proportion of patients meeting criteria for 12 practice measures modestly improved (65% pre QI-work; 78% post-QI work). There were no additional cases of urinary tract infections. Barriers to pathway development included difficulties with transforming manual measures into electronic data sets and accounting for portions of care that occurred at outside facilities. Updated outcomes will be presented. Conclusions: Creating evidence based clinical care pathways for addressing the acute care needs of patients with glioma is important. There are many challenges, however, to developing sustainable systems for measuring and reporting performance outcomes overtime.
Effect of inpatient radiation delivery on length of stay and health care costs.
Authors: Pintova Sofya , Holcombe Randall F. , Blacksburg Seth , Friedlander Philip Adam 
Published: February 2017

225 Background: Healthcare costs continue to rise. Identifying areas for healthcare utilization savings may be useful in reducing costs. The goal of this pilot study was to identify oncologic patients who remained in the hospital to receive radiotherapy treatment with the purpose of measuring length of stay (LOS) and charges associated with delivering inpatient radiation. Methods: Between July 1, 2013 and July 31, 2013 patients receiving inpatient radiation were identified. Actual LOS and end of acuity LOS were determined from the chart review. Expected LOS was calculated using the UHC database. Charges associated with actual LOS, end of acuity LOS and expected LOS were then reported. Comparisons of the actual and expected LOS were made between the radiation and non-radiation cohorts. Results: Seven patients were identified as remaining in the hospital to receive radiation treatment. There were 50 solid oncology patients admitted during July 2013 that did not receive radiation therapy. The seven patient cohort accounted in total for 281 days of hospitalization, with an average of 40.1 (+/-43.3) days per patient. The end of acuity LOS averaged 25.6 (+/-42.8) days per patient. The mean LOS attributed to radiation alone was 10.7 days. In contrast, the actual LOS for the 50 patients admitted to the solid tumor oncology service without radiation treatment, was 6.7 +/-4.9 days. The patients receiving radiation had a statistically significant longer actual LOS 40.1 vs 6.7 days (p<0.0001). The expected LOS for patients who received radiation was on average 7.7 days versus 5.2 days in the cohort that did not receive radiation, (p=0.0098). In the radiation cohort, the charges associated with the actual LOS per patient, end of acuity LOS per patient and expected LOS per patient were respectively $48,724, $34,089 and $10,028. The charges attributed to radiation alone amounted to $12,514 per patient. Conclusions: Delivery of radiation therapy during inpatient hospitalization extends LOS and contributes to higher healthcare costs. Methods to address this issue may result in cost savings.
Improving the quality of multidisciplinary care for head and neck cancer.
Authors: Lewis Carol M. , Nurgalieva Zhannat , Lai Stephen Yenzen , Weber Randal S. 
Published: February 2017

232 Background: As specialty- and disease-specific treatment recommendations based on the best available evidence and/or expert consensus, clinical practice guidelines such as those set forth by the National Comprehensive Care Network (NCCN) establish the current standard of quality care; adherence to these guidelines can serve as a measure of the quality and effectiveness of care. We aimed to assess multidisciplinary conference (MC) treatment recommendations’ adherence to NCCN head and neck cancer guidelines, while identifying potential areas for quality improvement. Methods: Patients presented with previously untreated head and neck cancers are being prospectively accrued as they are presented at weekly MC. The charts of patients presented between 10/20/2011 and 10/20/2013 were reviewed for clinical data leading up to MC to allow us to assess whether, based on the available information, the recommendations of conference are compliant with NCCN treatment guidelines. Results: Of 556 enrolled patients, 49.1% had oropharyngeal cancer, 28.2% had oral cavity cancer, 19.3% had laryngeal cancer, and 3.4% had nasopharyngeal cancer. For the entire cohort, the mean age at presentation was 58.9 years (16.4 - 89.3). Four hundred forty three patients (79.7%) were men. The recommendations of conference were non-compliant with NCCN treatment guidelines for 6.2% patients (17/273) with oropharyngeal cancer, 13.4% patients with oral cavity cancer (21/157), 0.9% patients (1/107) with laryngeal cancer, and 15.8% patients (3/19) with nasopharyngeal cancer. The most common reasons for non-compliance were recommended treatment of N2 oropharyngeal disease with definitive radiation alone (13 patients) and recommended over-use of induction chemotherapy (14 patients). Conclusions: NCCN guideline compliance can be used to evaluate the quality of head and neck cancer care. We have identified areas for potential improvement within our institution. Further study is needed to evaluate how care that deviates from NCCN guidelines affects patient outcomes.
Development and implementation of a longitudinal quality assessment for community outreach programs.
Authors: Martins Yolanda , Gonzalez-Suarez Elizabeth , de Zengotita Luis , Contreras Magnolia , Levine Anne L 
Published: February 2017

235 Background: Part of Dana-Farber Cancer Institute’s mission is to educate the community and raise awareness about the importance of cancer prevention, outreach, screening, early detection, clinical trials and survivorship. Development of a logic model and evaluation plan enables us to assess program quality and identify areas for improvement and future outreach. Methods: A forward logic, iterative approach was used to develop logic models for our community outreach programs. Models were reviewed by key stakeholders including program staff and management. These were used as the basis for a comprehensive logic model encompassing the common elements across all programs. Results: Seven logic models were developed to capture work in tobacco, sun safety, breast health, obesity prevention, community education programs, as well as comprehensive community benefits program model. We designed a developmental evaluation to allow for an assessment that could be adapted in a dynamic, ever-changing environment. This approach is also responsive to program growth and changes. It measures demographic information about our community participants, satisfaction with our programs, and strength of our community partnerships and compares these to internal benchmarks and state information. We can re-contact participants for on-going assessments and provide cross-sectional and longitudinal reports. RedCap freeware was used to create online versions of all tracking measures. Since (date) we have captured information from 119 community participants, most of whom are Black and Latino/a, and are representative of traditionally underserved minorities. Conclusions: Logic models and evaluation plans are integral components of community outreach programming. They ensure that effective, high-quality community outreach programming is being delivered, allow for the assessment of impact and assessment against program benchmarks. More importantly, they provide continuous information about areas for program growth and improvement.
Identification of quality care standards and development of indicators in oncology.
Authors: Camps-Herrero Carlos 
Published: February 2017

239 Background: Continuous assessment of clinical practice is a fundamental strategy for improving quality care. The generation of indicators in the context of clinical practice standards is the key factor for its success. The purpose of this work is to identify and establish standards in medical care of patients with breast, lung and colon cancer and to develop their indicators. Methods: The project was performed in 4 cycles: (1) Identification of clinical care standards for patients with lung, colon and breast cancer through research for scientific evidence. It was structured in four stages: diagnosis and treatment for every cancer and organisation of palliative care services at the end of life, equal for all three groups. (2) Revision of standards by an expert group of 9 oncologists. (3) Selection of standards for the generation of the indicators using the Delphi method, modified by a panel of experts consisted of 39 oncologists. (4) Development of indicators for the selected standards. Results: During the first revision 98 recommendations and standards were approved and selected by the group of experts and presented to the second panel of experts. Finally through the Delphi method 50 standards were selected, applicable to national level. For each one of the 50 standards an indicator was formed, 10 indicators for the organisational stage, 10 for the palliative care and 10 indicators specific for the diagnosis and treatment of each one of the cancer groups (colon, breast and lung). Conclusions: A total of 50 indicators were generated as measurement of parameters related to the quality of clinical practice and the organisation of care for patients with breast, colon and lung cancer. Their use is fundamental in identifying areas for improvement that will allow the identification of future strategies of quality care.
Value proposition for colorectal cancer (CRC) screening (SC) in underinsured populations (UP).
Authors: Barzi Afsaneh , Sadeghi Sarmad 
Published: February 2017

24 Background: SC for CRC is an effective preventive tool. In ASCO 2013 we reported that costs of SC are quickly offset by a reduction in the management costs of CRC rendering No Screening financially unsound. This is particularly relevant to the Medicaid and other UP where low reimbursements result in lower availability and inconsistent practice of SC creating an impediment to better outcomes and is a key part of outcome disparities. Methods: Twelve strategies (STs) and 1.4 million individuals were simulated to examine the role of participation (PA) in the SC on effectiveness and cost effectiveness of each SC ST. Individuals > 50 with average risk of CRC and 1/1 male to female ratio were followed for up to 35 years with SC stopped at 75. PA was increased by 10% increments between 20% and 80%. Results: Our results demonstrated that FOBT and colonoscopy (CS) are consistently cost effective STs independently of the level of PA. The incremental cost effectiveness ratios (ICER) of CS relative to FOBT remain flat as PA increases. The absolute difference in life years gained between FOBT and CS ranges from 0.014 to 0.30. Sensitivity analysis reveals that costs of FOBT can be increased before CS becomes more cost effective. Conclusions: Given the limitations of resources within provider networks primarily supported by Medicaid, FOBT can be deployed as the SC modality of choice and efforts maybe focused on increasing PA. To this end, Medicaid can potentially offer more competitive reimbursement rates for fecal testing, thereby incentivizing providers. This will improve quality as reflected in the outcomes and is more pragmatic in terms of resources it requires. [Table: see text]
Model of quality care indicators for patients with colorectal, lung, and breast cancer.
Authors: Diaz-Rubio Eduardo 
Published: February 2017

241 Background: The care of an oncology patient is a complex process with important clinical, social and financial repercussions. The purpose of this work is to develop quality care indicators for the medical care of patients with cancer. It is fundamental that health organisations adopt such models based on quality standards with the intention to promote excellence in the care of cancer patients. Methods: Research for scientific evidence, revision and selection of standards using the Delphi method was employed and definition of indicators was established. Results: 50 quality indicators were created directed to: Organisation: Multidisciplinary committees; informed consent; patient security; elapsed time between diagnosis and treatment; tumour registry; treatment protocols. Colorectal cancer: Histopathology report and markers; chemotherapy for advanced/metastatic cancer; evaluation of staging of colorectal cancer; liver metastases; adjuvant chemotherapy; evaluation of history family; biological therapy and RAS gene mutation; radiotherapy; quality of surgical notes. Breast cancer: Histopathology report and markers; initial staging; hormonotherapy; other treatments; elapsed time between histological diagnosis and treatment and between surgery and adjuvant treatment; pre-operative assessment and conservative surgery focused on the armpit; access availability to initial radiological studies.Lung cancer: Histopathology report and markers; initial staging; elapsed time between histological diagnosis and treatment; concomitant chemoradiotherapy; evaluation of chemotherapy response; adjuvant chemotherapy; elapsed time till the completion of staging; surgery; chemotherapy with good functional status; adjuvant radiotherapy; concomitant chemoradiotherapy for small cell lung cancer. End of life: Organisation of palliative care; outpatient attention; identify patients; access to care; pain management; information availability; psycosociological support; constipation management; counselling of family after death. Conclusions: The indicators constitute a reference model based on standards in order to measure care quality and to compare achieved results among health institutions.
Adjuvant chemotherapy selection for stage I NSCLC 2011 through 2014 in the southeastern United States.
Authors: Mamgain Avinash , Huff Dinah Faith Q. , Bennett Charles L. , Shimp William S. , Baranwal Anmol , Bobolts Laura Rose , Armitage Melissa , Davis Sharon , Schorer Anna E. , Fishman Marc L. , Fishman Val , Walton Robert , Kogler Jurgen , Hrushesky William J. 
Published: February 2017

248 Background: Among patients with early stage non-small cell lung cancer (NSCLC), appropriate use of adjuvant chemotherapy is an important determinant of survival. Existing level 1 data, which includes analysis of five cisplatin-based phase III trials (IALT, BLT, ALPI, ANITA, NCIC-CTG-JBR.10), two carboplatin-based phase III trials (CALGB 9633 and NATCH Trial), and two meta-analyses (LACE, MRC), demonstrate only cisplatin-based adjuvant chemotherapy regimens enhance overall patient survival. Most importantly, these studies also reveal that survival advantage from adjuvant chemotherapy does not extend to stage I patients, but only to stage II-IIIA patient subgroups. Unplanned a posteriori subset analyses indicate the possibility that certain stage I NSCLC with one or more "high risk" characteristics may benefit from cisplatin-based adjuvant chemotherapy. This hypothesis must be properly tested before it can be adopted. We, herein, hypothesize that many US stage I NSCLC patients are routinely treated in the adjuvant setting with regimens that have not demonstrated level one overall survival benefit. Methods: We examined chemotherapy request data for stage I & II NSCLC, submitted to a private health insurer by oncologists for the adjuvant treatment of NSCLC patients in the southeast US from January 2011 through May 2014. Results: Overall, 25% (67/264) of adjuvant chemotherapy requests were for stage I NSCLC patients (potential overuse). The frequency of these requests has increased over time: 17% in 2011, 20% in 2012, 30% in 2013, 34% in 2014. Four out of five of patients with stage I NSCLC (52/67) were given carboplatin-based regimens, while only one in five (19%, 13/67) received cisplatin-based regimens, and 3% (3/67) were pemetrexed-based regimens (potential misuse). Conclusions: High misuse and overuse rates of adjuvant chemotherapy for stage I NSCLC are observed among the privately insured populations of Florida, Texas and Georgia. Quality improvement initiatives in this patient population may be indicated to prevent potential harm from treatments advised against by ASCO, ESMO, NCIC, NCCN and UK guidelines.
Regional initiative to define, collect, and report value metrics in cancer care.
Authors: Kreizenbeck Karma L. , Hughes Erin E. , Stewart F. Marc , Brown Thomas David , Chen Eric Y. , Corman John M. , Curry Thomas , Glenn Michael , Lonergan Matt , Martins Renato , Rieke John , Saikaly Elie P. , Szalwinski Mark , Chauhan Rakesh T , Lyman Gary H. , Ramsey Scott David 
Published: February 2017

25 Background: In the context of numerous national initiatives aimed at measuring quality and value in cancer care, the Hutchinson Institute for Cancer Outcomes Research, in partnership with local healthcare delivery organizations, patient advocacy groups, payers, and policymakers launched a regional, stakeholder-driven initiative to define 3-5 “value-based metrics” for cancer care for Washington State. Methods: Representatives from major cancer care delivery organizations, patient advocacy groups, payers, and policymakers were invited to participate in a day-long Value Summit. Attendees were tasked with identifying metrics that considered both costs and outcomes. Trained facilitators helped participants identify metrics for 9 domains: appropriate use of effective therapies, adherence to best practices, survival, comprehensive disease management, efficiency of care, hospice/palliative care, patient and family satisfaction with care, patient reported outcomes/preferences and safety. After the initial list was generated, attendees were then asked to rank the metrics on the basis of feasibility to collect, clinical relevance, ability to act on, meaningfulness to multiple stakeholders, and willingness to report statewide. Attendees were then asked to participate in 3 domain-specific facilitated breakout sessions to prioritize the top metrics for each domain. Breakout sessions reported top metrics for a final group prioritization exercise. Following the Summit, attendees provided feedback on the final rankings. The metrics were then presented at a Town Hall style meeting for public comment. Results: Over 70 participants, representing 20 different organizations, identified 750 unique metrics from 9 domains. The prioritization process yielded 3 areas of interest, with 2 specific metrics within each: end of life and palliative care (metric 1, metric 2); adherence to best practices (metric 3, metric 4); and coordinated and efficient care (metric 5, metric 6). Follow-up surveys of Summit attendees and the Town Hall forum showed widespread support for these metrics Conclusions: Using an iterative, transparent, multi-stakeholder process, it is feasible build regional consensus around value metrics in cancer care.
Universal truths: Learning from the experience of cancer patients in Australia and England.
Authors: Lacey Karen , Schofield Penelope , Krishnasamy Meinir , Lethborg Carrie , Cashill Elizabeth , Thompson Eileen , Butty Jill , Mollo Adele , Morrone Assunta , Byrne Jenny , Bishop James F. 
Published: February 2017

255 Background: Self-reported patient experience data is vital to the design of responsive and relevant health services. Annual Cancer Patient Experience Surveys in England (NHS-CPES) have been used to effectively guide and monitor improvements in patient experience. This study measured baseline cancer patient experience in member hospitals of the Victorian Comprehensive Cancer Centre in Australia, and benchmarked this with cancer patients in England. Methods: The NHS-CPES instrument and methodology was used. A paper-based questionnaire was mailed to 5,722 admitted patients aged >18 years with an eligible ICD-10 code. Australian results were compared to 71,793 patients in England from the 2011/12 NHS-CPES. Results: 37% (2,101) patients responded. Most patients rated their overall care as very good or excellent (91% Australia, 88% England). Having a named nurse specialist was a key predictor of experience. Patients with a specialist nurse were significantly more positive in 50 questions in Australia (77%) and 64 questions in England (98%) compared to patients without one. In both countries, patients with rarer cancers tended to be less positive than those with other cancer types. Australian patients with brain/central nervous system cancers and sarcomas gave the lowest score in 46 questions (71%). Patients with a disability or a long-term condition, and those from minority ethnic groups were also less positive. Relevant patient information was lacking; only 65% of patients in Australia and 77% in England were given understandable written information specific to their care, and a little over half received information about financial entitlements (58% Australia, 52% England). Conclusions: Cancer patient experience using the NHS-CPES has been successfully measured and compared across two different health systems. Findings in Australia are similar to those in England suggesting the same key issues affect all cancer patients. Important areas for quality improvement include the provision of tailored written patient information and the provision of named nurse specialists as part of the model of care. Acknowledgement: The authors thank Quality Health Limited for data analysis and the NHS for permitting use of the NHS-CPES.