bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving code status documentation as a marker of advanced care planning at an outpatient academic cancer center: A pilot project.
Authors: Ranganathan Anjana , Sauerbaum James J. , Green Katie , Sheaffer Heather , Coniglio Mary , Evans Tracey L. 
Published: February 2017

38 Background: Advanced care planning can significantly impact the quality of end of life care. Readily accessible documentation of goals of care for patients (pts) known to have a high morbidity and mortality provides a concrete means for practitioners to discuss and guide advanced care planning. We previously reported a surprisingly small proportion of established pts in our oncology clinic with a documented code status (CS), and undertook a pilot project aimed at improving this rate. Methods: Query of the outpatient electronic medical record (EMR) at the Abramson Cancer Center for established pts revealed an average of 2% with a documented CS. Our pilot study focused on 8 providers in thoracic and gastrointestinal oncology. We established provider agreement on the importance of CS documentation, and analyzed the mechanisms in place for documentation. We educated providers on the method of documentation, raised visibility and importance of advanced directives, implemented a system of normalizing conversations for all new pts, reported weekly to providers on upcoming established pts without documentation and provided monthly report cards, indicating provider rates within the pilot group. Results: Prior to intervention, a median of 499-established pts per month were seen by our pilot group. A median of 50 pts (10%) had a documented CS with documentation rates by provider ranging from 0 – 91%. 5 of 8 providers had no established pts with a documented CS. After intervention, a median of 494-established pts per month were seen by the same group. A median of 197 pts (40%) (p < 0.05) had a documented CS with provider rates ranging from 26 – 94%. All providers had documented a CS on at least some of their established pts; improvements ranged from an increase of 0 to 26%, to an increase of 1 to 43%. Conclusions: Previously, at our institution, only a small minority of established patients with an oncologic diagnosis had documentation of CS in the readily available EMR. Our pilot study resulted in a statistically significant increase in the documentation rates for all providers over a 2-month period. We have yet to analyze the clinical significance of this, with attention to quality and cost of end of life care.
Assessment of accuracy of data obtained from patient-reported questionnaire (PRQ) compared to electronic patient records (EPR) in patients with lung cancer.
Authors: Palepu Prakruthi R. , Brown Catherine , Joshi Gautam , Epsin-Garcia Osvaldo , Eng Lawson , Ramanna Jayalakshmi , Hon Henrique , Momin Salma , Pringle Dan , Cuffe Sinead , Waddell Thomas K. , Keshavjee Shaf , Darling Gail Elizabeth , Yasufuku Kazuhiro , de Perrot Marc , Pierre Andrew , Cypel Marcelo , Xu Wei , Liu Geoffrey 
Published: February 2017

40 Background: Cigarette smoking, alcohol consumption and co-morbidities are important determinants of health in lung cancer patients. The gold standard for obtaining accurate data is PRQ. The purpose of this study is to ascertain the accuracy of abstracting health-related behaviour data from retrospective chart review compared to data directly obtained from PRQ in a lung cancer patient population. Methods: 731 lung cancer patients completed a PRQ related to lifetime tobacco use, alcohol consumption and co-morbidity. Relevant smoking, alcohol and co-morbidity data was collected independently from EPR. Results: Ever/never status for smoking showed almost perfect agreement (k=0.95) between PRQ and EPR and surpassed all other health behavioural measures and co-morbidity agreement values. Both the sensitivity and specificity were high (0.94 and 0.99 respectively). The calculation of pack-years from EPR and PRQ showed substantial agreement (k=0.77); However, categorizing the smoking status into current/ former / never, resulted in moderate agreement (k=0.46). Alcohol ever/ never status agreement was moderate (0.43) with high sensitivity (0.90) but low specificity (0.50). Agreement for co-morbidities varied by condition showing moderate to substantial agreement for hypertension (K=0.57), heart attack (K=0.80) and diabetes (K=0.76) while fair to slight agreement (K<0.4) was seen in the others. Specificity was 0.86 or higher for co-morbidity conditions and was consistently higher than the sensitivity. Conclusions: EPR may be used as a reliable surrogate to PRQ in determining ever/never smoking status and lifetime smoking exposure. Evaluation of current/former/never smoking status and alcohol consumption is best determined by PRQ. Diabetes, hypertension and heart attack are more accurately reported in the PRQ than other co-morbidities. Patients tend to report absence of a medical condition more accurately than the presence of it. Missing EPR data related to smoking pack years, alcohol consumption and lung co-morbidities is concerning and suggests more synoptic reporting by physicians would improve opportunities for research.
The six IOM quality aims in practice: A multidisciplinary assessment of the scope and focus of quality activities in oncology.
Authors: Hurwitz Mark , Harrison Amy , Doyle Laura , Bar-Ad Voichita , Smyles John , Siglin Joshua , Munro Susan , Itri Alisa , Wilson Kathleen , DeGregorio Nicholas , Clancy Daniel , Lowther Ann , Dicker Adam 
Published: February 2017

44 Background: Strategies to address quality have evolved through adaptation of best practices, need to address institutional priorities, and mandates from accreditation organizations. Therefore evolution of QA/QI practice has been mostly reactive in nature. In the IOM report “The Quality Chasm” 6 key quality aims were identified: safety, timeliness efficacy, equitability, patient centeredness, and efficiency. To date however, a comprehensive assessment of the relationship of quality activities in oncology to these aims has not previously been reported. We hypothesized that there is variability in focus and scope of quality related activities in oncology as they pertain to the IOM key quality aims. Methods: Multidisciplinary quality activities in our department were identified by our quality committee. For each activity, 10 committee members individually identified in their opinion which of the 6 IOM quality aims were addressed by that activity and ranked in order the relative focus of each identified aim per activity. The percentage of respondents associating an aim to an activity and relative focus score per activity (1-6 with 1 representing the primary focus) were tabulated. Results: Imbalance with emphasis on safety was noted. Average relative focus scores linking the six quality aims to each quality activity are shown in the Table. Conclusions: Review of department quality activities revealed imbalances in focus on the IOM quality aims. While there is relative emphasis on safety as expected, opportunities exist for development of activities focused on other quality aims including timeliness and equitability. [Table: see text]
Are patients' needs being met after hours? An evaluation of phone calls made after hours for patients with thoracic malignancies.
Authors: Patel Manali I. , Moore David , Milstein Arnold , Wakelee Heather A. , Blayney Douglas W. 
Published: February 2017

46 Background: Understanding phone calls patients make after hours is important as it represents opportunities to provide improved care. Furthermore, better understanding of after-hours calls can help to influence reductions in healthcare spending. Therefore, we sought to evaluate the nature of after-hours calls to the thoracic oncology clinic. Methods: The study is a retrospective analysis of 4 months of phone calls made to the Stanford Cancer Institute during weekends and hours of 5pm-8am on weekdays. On-call physicians documented complaint, age, gender, and advice given. Phone calls were excluded from analysis if there were missing information. Differences in proportions were analyzed by Fisher's exact test. A two-sided p value <0.05 was considered significant. Results: There were 271 phone calls made after-hours by patients with lung cancer however after exclusions, there were 215 calls for analysis. The majority of phone calls occurred between 5pm-11pm (n = 57; 173%) followed by daytime calls during the weekend (n = 37; 17%). A majority of phone calls were made by the patient (50%) with a slightly lower proportion made by family members (46%). The majority of patients who called were in their 50’s (29%) and female (54%). A high proportion of patients called for more than one complaint (30%) although almost all patients complained of more than one symptom on review of systems (95%). The main symptoms patients called for were cough (28%) and shortness of breath (27%). Of the phone calls, 62% (133) were referred to the emergency room. Of those patients referred to the emergency department, 77% (103/133) resulted in an admission. Conclusions: Most after-hours phone calls from patients with lung cancer are related to symptoms. A large proportion of patients who were referred to the emergency department subsequently required an admission. Analyses of call content, and of events leading to the after hours calls might help predict hospital admission in this group of patients, and will inform development of proactive interventions to improve the quality of care, patient-centered outcomes, and value.
Reducing breast cancer chemotherapy treatment delays by improving the transition from surgical to medical oncology.
Authors: Losk Katya , Kadish Sarah , Golshan Mehra , Lin Nancy , Hirshfield-Bartek Judith , Cutone Linda , Bunnell Craig A. , Weingart Saul 
Published: February 2017

51 Background: Delayed chemotherapy is associated with adverse clinical outcomes for breast cancer patients. Few studies have examined the processes of care within administrative staff and providers’ control that might affect the timeliness of breast cancer care. Coordinating transitions of care from surgical to medical oncology to eliminate variation is essential in ensuring timely chemotherapy for patients after surgery. This study evaluated the time of transition from surgery to medical oncology when administrative change of practice was implemented. Methods: We studied 192 consecutive breast cancer patients who received adjuvant chemotherapy. The interval between last definitive surgery and initiation of chemotherapy was calculated by integrating billing and scheduling data. Using process improvement methods a multidisciplinary team identified the opportunity to reduce delays in care coordination by scheduling the surgery, surgical post-op appointment, and medical oncology follow-up appointments simultaneously. Furthermore, responsibility for scheduling the medical oncology follow-up appointment was shifted and standardized from medical to surgical oncology administrative staff. Criteria for acceptable timeliness of appointments and escalation pathways for when provider availability was limited were established. The intervention targeted patients whose initial consultation with a breast surgeon and medical oncologist occurred on the same day, the standard practice at our institution. Results: Implementation of the interventions decreased the time from surgery to chemotherapy by six days. The standard deviation also declined, suggesting that the intervention reduced process variability. Conclusions: Standardizing administrative practices between breast surgery and medical oncology has led to a significant decrease in the time from last definitive surgery to initiation of chemotherapy and in the variability of that delay. [Table: see text]
Positive reactions of hospital staff to feedback by specialists.
Authors: Nakamoto Nana , Nakamura Fumiaki , Higashi Takahiro , Amano Asuka , Fukuchi Misato , Hirayasu Masako , Higa Hatsue , Asato Kuniko , Shimada Yasuhiro , Yoshikawa Takaki , Ono Hiroyuki , Tanaka Shinji , Ishiguro Megumi , Masuda Masato 
Published: February 2017

57 Background: Although cancer is the leading cause of death in Japan, systematic quality monitoring of cancer care has not been established. In an attempt to explore such systems, we measured the quality of cancer care in several facilities through chart reviews by tumor registrars. The subsequent step is the provision of effective feedback of these results to the practicing physicians and other health professionals for further improvement. However, the receptiveness of lead practicing physicians may be debatable. Methods: We measured 23 quality indicators (QIs) (10 indicators for stomach cancer and 13 for colorectal cancer) in 10 designated cancer hospitals between 2010 and 2011. The staff who worked in these hospitals could see results of the measured QIs on web pages. All three designated cancer hospitals and one large general hospital in Okinawa Prefecture participated in feedback meetings. A feedback meeting was held in each of the four hospitals for one hour each. The feedback meeting consisted of three parts: general explanation of the measured QIs by the researcher, feedback regarding results of each indicator by the panels, and discussions. At the end of the meeting, participants answered a questionnaire regarding the meeting. Results: Of the 190 hospital staff who participated in the meeting (52 were medical doctors, 21 were nurse, 15 were other medical staff, and 102 were medical clerks), 142 (75%) answered the questionnaire. Majority of the responses were supportive of the quality measurement and feedback activities: 85% of the participants understood results of the measured QIs and 94% replied that the feedback methods were good. In addition, 86% answered that they would recommend other hospitals to participate if there was an opportunity. Among the physicians who participated, 89% answered that results of the measured QIs would influence their practices and 95% answered that data abstraction by tumor registrars was appropriate. Conclusions: Feedback by the panels who established QIs was favorably perceived by the hospital staff and could influence the attitude of physicians regarding current practices.
Fertility preservation cost and use: Results from the LIVESTRONG survey.
Authors: Rechis Ruth , Nutt Stephanie , Bann Carla 
Published: February 2017

59 Background: Each year nearly 70,000 adolescents and young adults (AYAs) are diagnosed with cancer. Recently, steps have been taken to address infertility, which is an important issue experienced by AYAs. For example, ASCO QOPI includes fertility standards and Walgreens and the LIVESTRONG Foundation provide financial assistance for fertility preservation medications. To better understand the current state of fertility preservation, eight questions on this topic were included on the LIVESTRONG Survey. Methods: From June to December 2012, LIVESTRONG conducted an online survey (N = 6,313). Analysis here includes the 1,333 AYA respondents who were diagnosed since 2002. Results: Only 24% of respondents (42% of males, 12% of females) indicated they took steps to preserve their fertility before beginning treatment. Top reasons for not preserving their fertility were not receiving information about options (19%) and/or information about the risks to their fertility (14%). For the AYAs who did preserve their fertility, the median amount spent on fertility expenses was between $1,000 and $2,499 (Table) with males spending significantly less than females (p < 0.001). Mostly commonly, males used sperm banking (97%) while females used egg and embryo banking (each 35%). The majority all who attempted to become pregnant were successful (58% and 68% respectively). Conclusions: Results from this analysis indicate that few survivors took steps to preserve their fertility before starting treatment. Yet for those who were interested in preserving their fertility and starting a family, the majority of individuals were successful. Many individuals reported not preserving their fertility due to a lack of information or resources. While a relatively small number of survivors will have fertility concerns, this is an important quality of life issue for those who do. [Table: see text]
Pragmatic approach to quality metrics development in cancer.
Authors: Chung Donna , Dwarakanath Aniruddha , Williams Charlotte , Pritchard-Jones Kathy , Mountford James , Mayer Astrid 
Published: February 2017

60 Background: London Cancer aims to use transparency of service and quality measures to drive improvement in cancer care in North and East London and surrounding areas, serving our population of 3.5m people. Whilst the on-going implementation of the National Outcome and Service Dataset for UK is expected to take 18 months we have chosen to develop quality measures with the teams accountable to deliver the service by using available data from a variety of existent sources and illustrate this in value scorecards tracking the patient pathway. Methods: Building on an engagement exercise with patients, clinicians and charities in 2011 to identify which outcomes mattered most to patients, a small set of key pathways metrics was identified for each site specific cancer pathway board to monitor their progress in implementing integrated cancer care. Metrics were selected only if (a) clinically useful, in line with the current work plan and improvement effort; (b) accessible on a recurrent basis and requiring minimal manual effort; (c) facilitate the understanding of the patient pathway; (d) align with London Cancer objectives in improving survival, patient experience, and access to innovation and clinical trials. Pathway boards were invited to contribute with the intention to provide a pathway metrics value scorecards on a quarterly basis. Results: The first set pathway metrics scorecards, with 31 metrics, were published by June 2013. Key items include adherence to established best practice (16), data completeness (6), survival (3), pathway efficiency (3), and patient experience (3). Conclusions: Pathway metrics are reported at a system level, reflecting the care for our local population, against measures that are important to them and will allow visibility of success. Whilst current pathway metric development is limited by the availability of meaningful data we aim to build on the existing metrics in an iterative fashion. For this we are working with stakeholders to improve data quality.
City of Hope's referring physician communication process improvement initiative.
Authors: Alvarnas Joseph C. , Avanessian Priscilla , Wakabayashi Mark Tsuneo , Kassab Tricia , Levine Alexandra M. 
Published: February 2017

63 Background: City of Hope’s (COH) Performance Excellence Program (PEP), a physician incentive program aimed at improving quality and process outcomes, identified the need to establish a process for strengthening COH’s relationship with referring physicians. Methods: Working in collaboration with New Patient Services, Marketing, and physicians across multiple disciplines, we implemented a manual process of copying information in all H and Ps/Admit Notes, discharge summaries, consultation notes, and operative reports to referring MDs if the COH MD had not done so. The PEP team is also in the process of establishing a specific COH referral MD line that would allow for priority queuing and a real-time warm transfer to the MD/ MD’s office. Marketing of the number will be conducted through a standard thank-you cover letter sent by every COH MD upon initial consultation of patient, as well as through a newly revamped physician website. The implementation of a Health Information Exchange is also in progress. Results: Overall satisfaction on COHs ability to communicate increased from 23% to 30%. Number of 10 or more updates received from COH increased from 0% to 17%. Those who referred 20% of their patient volume increased from 15% to 20% while those who only referred 1-5% decreased from 69% to 30%. Conclusions: Through the multiple strategies and joint efforts across disciplines, COH has strengthened its relationship with referring MDs and increased its referral volume. [Table: see text]
Streamlining federally mandated quality metric reporting in cancer care.
Authors: Kidin Lisa M. , Walters Ronald Stewart , Browning Doug , Taylor Sarah H , Jordan Victoria S. 
Published: February 2017

68 Background: Public reporting has been an established process for non-PPS exempt hospitals since the inception of the Core Measures in 2001; however, Cancer Centers were not subject to public reporting and had no standardized established formal mechanism to collect, analyze and report clinical quality data until the Affordable Care Act (ACA) of 2010. The first three Clinical Process/Oncology Care Measures must be submitted through the American College of Surgeons Rapid Quality Reporting (RQRS) system. Since registries are designed to provide a retrospective snapshot of the patient population during the first four months of the disease process, the change to longitudinal data collection, while critical for intervention in time to improve concordance, is extremely difficult for cancer centers with large volumes and complex cases. Our institution created a collaborative interdisciplinary model utilizing quality management nurses to support and enhance the submission process by utilizing an early identification and intervention process. Methods: Prior to implementation, the average submission time for the initial three oncology specific metrics was eight months due to the significant effort to determine the analytic population based on our volume of patients. In addition, many patients receive treatments outside the facility with little or no documentation that often resulted in the inability to determine metric concordance. Results: The new process identified patients at two months and created a robust follow up and validation process utilizing a model to ensure evidence based care is provided across the continuum. This enabled monthly submission to RQRS at the end of three months and leveraged the system to ensure that patients had the appropriate therapy documented in the system. This process shortened the submission time to less than half and initial projections indicate increased overall compliance. Conclusions: We enhanced the process of submission for federally mandated measures to RQRS by initiating early identification and follow up. This significantly impacted our ability to accurately represent the high quality care provided at our institution and provide documented concordance with national quality measures.