bluuebunny/crossref_metadata_2025_split huggingface dataset:
Younger survivors' insurance concerns.
Authors: Rechis Ruth , Nutt Stephanie , Bann Carla , Squiers Linda 
Published: February 2017

277 Background: Each year approximately 70,000 adolescents and young adults (AYAs) are diagnosed with cancer—many of whom will experience insurance issues. While the Affordable Care Act (ACA) is intended to address many insurance issues, cancer survivors are dealing with these issues now. Methods: From June to December 2012, LIVESTRONG conducted an online survey modeled after the Medical Expenditure Panel Survey (MEPS) Cancer Survivorship Supplement to understand the practical concerns of survivors, including insurance issues. Analyses here includes 1,209 AYA respondents compared to 3,557 respondents diagnosed over the age 40. Results: Overwhelmingly, participants in this survey had insurance at some point since diagnosis (94%), yet AYAs were significantly less likely to have had insurance (p<.001). AYAs were significantly more likely to have experienced issues with insurance (Table), but both groups were unlikely to have received help for negative effects due to insurance (AYA = 30%; non-AYAs=25%). In terms of help seeking, AYAs were significantly more likely to have received help from family members (p<.001). Both groups indicated a number of reasons for not seeking help for insurance issues - most frequently citing "I have addressed this on my own” (18%) and “I tried to receive help but was unsuccessful” (17%). Conclusions: Results from this study indicate there are many issues related to insurance coverage for survivors, which in most cases were significantly more impactful for AYA survivors. Additionally, there are many challenges survivors face in terms of getting their insurance needs met. Finally, it’s important to consider the full implications of what it means for AYAs to be reliant on family members – for both the survivor and their family. The AYA period often denotes a time that individuals are trying to separate from family, yet cancer may make this separation considerably more challenging. While ACA is intended to address some of these issues, cancer survivors are dealing with insurance issues now, and we should consider how to address these issues more quickly. [Table: see text]
Improving the rate of influenza vaccination in pediatric patients with cancer.
Authors: Freedman Jason Lawrence , Reilly Anne F. , Bailey L. Charles 
Published: February 2017

49 Background: Pediatric patients with cancer are at increased risk of influenza, with high mortality, morbidity, and delay of cancer therapy. CDC guidelines support yearly vaccination in these patients. In prior years at our center, only 53-56% of pediatric cancer patients received at least one dose of the vaccine. Our objective was to increase the rates of influenza vaccination in pediatric cancer patients through a multi-faceted QI initiative. Methods: Five interventions were instituted concomitantly, in eligible patients (>6 months old, >100 days from BMT if applicable, and within 1 year of chemotherapy) over a 6-month period (9/1/12 to 3/31/13). 1) Family education: provision of influenza/vaccine handouts to families in clinic waiting rooms; 2) Health informatics intervention: via electronic health records, generation of daily lists of patients due for doses with automated email lists to triage and nurses; 3) Clinical process interventions: standardization of triage process to identify patients needing vaccination and provision of colored wristbands to such patients alerting providers to order the vaccine, or document refusals, during the encounter; 4) Inpatient orders: influenza vaccine order built into computerized physician admission order set to trigger vaccination upon discharge; and 5) Provider education: printed materials and tutorials for staff at conferences on proper screening of patients, vaccine ordering/dose, and correct documenting of refusals/contraindications. These processes were iteratively refined over the 6-month timeframe. Results: Influenza immunization rates increased by 20% after the changes were implemented; this was seen across all tumor subgroups. Overall, 74% of patients received at least one dose as compared with 52% in the prior year. 61% of patients were fully immunized (vs. 42% in 2011-12). Immunizations were deferred due to allergy/refusal in 8% of patients (vs. 7% in 2011-12). Consequently, only 18% of eligible patients were unimmunized as compared to 41% in the prior year. Conclusions: Technology, education, and clinical process changes led to a successful increase in influenza vaccination rates. Ongoing efforts will target subgroups with lowest overall rates of immunization.
Augmenting state cancer registry data for quality-of-care assessment: A Georgia-based application to evaluate receipt of adjuvant therapies for breast cancer and colorectal cancer.
Authors: Lipscomb Joseph , Ward Kevin C. , Adams Kathleen , Joski Peter , Roblin Douglas , Gillespie Theresa Wicklin , Li Juan 
Published: February 2017

5 Background: The value of linking population-based cancer registry data with insurance claims files to assess quality of care has been demonstrated in numerous studies, including those using NCI’s linked SEER-Medicare database, covering patients age 65+ in fee-for-service plans, and studies linking registry data with Medicaid, private insurance, or managed care data covering the under-65 population. We describe a prototype program linking registry data with multiple data sources to assess quality of care for at-risk populations in a defined geographical area. Methods: Data exchange agreements were executed among the investigative site (Emory University), Georgia state government, and the claims data sources/vendors. We linked Georgia Cancer Registry (GCR) records for 1999-2005 incident cases of breast and colorectal cancer with enrollment and medical services records from Medicare, Medicaid, Kaiser Permanente of Georgia, and the State Health Benefit Plan (SHBP) which covers all state workers and dependents. Following data quality checks, algorithms based on National Quality Forum (NQF) endorsed breast and colorectal cancer quality measures were applied to each linked data set to assess performance. Results: The linked data sets included 60% of all breast and colorectal cancer cases in the GCR over the study period. Quality measure performance rates varied notably across payers. For example, the percent of Stage III colon cancer patients meeting the NQF standard for adjuvant chemotherapy in the linked GCR-Medicaid, GCR-Kaiser, and GCR-SHBP data were, respectively, 75%, 92%, and 92% (p<0.05). The rates for breast cancer patients meeting standards for adjuvant chemotherapy were 86%, 84%, and 87% (p=NS), respectively. Patients in the linked GCR-Medicare data (all age 65+) generally had lower performance rates for each NQF measure. Conclusions: Linking state cancer registry data with multiple public and private sources of administrative data is technically feasible, and may represent a viable strategy for building a national cancer data system for quality improvement, as recommended in 1999 by the Institute of Medicine.
Development and implementation of communities of practice at Cancer Care Ontario (CCO).
Authors: Mendelsohn Marissa , Breen Stephen , D'Souza David , Foxcroft Sophie , Fyles Anthony W. , Gutierrez Eric , Kim Joon-Hyung J. , Lockhart Elizabeth , Murray Elizabeth , Ravi Ananth , Sankreacha Raxa , Scott Dani , Zaza Khaled , Warde Padraig Richard 
Published: February 2017

58 Background: A “Community of Practice” (CoP) has been defined as a group of people who share a passion for something they do and learn to improve as they translate knowledge and interact together. Methods: The primary goal of the Radiation Treatment Program (RTP) at CCO is to improve the quality of care delivered to Ontario patients receiving radiation treatment. We identified variations in practice in the 14 Regional Cancer Centers (RCC) in Ontario and facilitated the development of 3 CoPs to share best practices and standardize care where appropriate. Through this initiative, two multidisciplinary [Radiation Oncologists, Physicists and Radiation Therapists (MRT(T)s)] CoPs have been established in Head and Neck (H&N) and Gynecological (GYN) Cancers and one discipline-specific CoP has been started in Radiation Treatment External Beam Delivery involving MRT(T)s alone . During initial meetings of each CoP key variations in practice affecting quality of care were identified. Results: Each CoP has developed recommendation documents for improving care: H&N Cancer – Nomenclature for anatomic structures in treatment volumes and Evaluation of Intensity Modulated treatment Plans; GYN Cancer – Imaging strategies for Intracavitary Brachytherapy of Cervical Cancer; Treatment Delivery – Protocol Development Toolkit and Image Guided Radiation Therapy Education Checklist. These recommendation documents are currently being piloted in each RCC with a view to standardizing care across the province. Conclusions: These CoP initiatives have enabled the development of recommendation reports by front-line staff to ensure evidence-based, high-quality radiation treatment to improve the safety and quality of care for all cancer patients across a jurisdiction of 13M people.
Evaluating the role of palliative care consultations in patients with advanced gastrointestinal cancers.
Authors: Paris Julia , Du Qingling , Morrison R. Sean 
Published: February 2017

6 Background: Though research shows that patients with terminal illnesses prefer to die at home, over 60% of patients with advanced cancer are hospitalized in the last month of life. Additionally, less than half of these patients receive any form of hospice care at the end of life, despite its demonstrated potential to improve quality of care. Inpatient palliative care (PC) consultations may serve as a bridge from hospitalization to receiving the kind of end-of-life care that patients prefer. Tumors of the gastrointestinal (GI) system include some of the most common and deadliest cancers and these patients can benefit from PC services, especially when the disease has reached an advanced stage. Our objective was to compare the effectiveness of inpatient PC consultations vs. usual care on post-discharge outcomes in patients with advanced GI cancers. Methods: 202 adults with advanced GI cancers admitted to 5 US hospitals were followed prospectively through hospitalization and 6 months post-discharge. 82 patients received a palliative care consult during hospitalization. Propensity scores were used to match treated to control patients, with exposure to a palliative care consult as the intervention. Outcome measures included: referral to hospice, subsequent ER visit, hospital readmission, and place of death. Results: Significantly more patients in the treatment group were referred to hospice upon hospital discharge (38% vs. 8%, p=0.000). 70 patients died in the 6-month follow-up period. Receiving a PC consult increased the odds of dying at home 3-fold (OR=2.9, p=0.046, 95% CI 1.02-8.44) and decreased the odds of dying in a hospital by 85% (OR=0.159, p=0.002, 95% CI 0.05-0.52). At 2 and 6 months post-discharge, significantly more patients in the treatment group were receiving hospice services at death (75% vs. 18%, p=0.001 and 82% vs. 24%, p=0.000 respectively). There were no significant differences between the two groups regarding hospital readmission and ER visits post-discharge. Conclusions: PC consults for patients with advanced GI cancers was associated with increased referral to hospice, decreased likelihood of dying in a hospital and increased likelihood of dying at home.
Evaluating adherence to off-label policy at an academic outpatient cancer center and assessing reimbursement of high-cost drugs.
Authors: Blouin Gayle C. , Chio Christine , Kim E. Bridget , Ryan David P. 
Published: February 2017

61 Background: An off-label policy was developed at Massachusetts General Hospital for drugs used in oncology to 1) ensure high quality standards across the cancer center, 2) promote safe and effective care and 3) demonstrate fiscal responsibility and accountability for drug costs. The purpose of this study is to evaluate adherence to the off-label policy around use of chemotherapy/biologics in outpatient oncology. The impact on pharmacy resources will also be evaluated. A secondary objective is to assess reimbursement of high cost drugs. Methods: A retrospective analysis was performed on all off-label requests submitted from May 1, 2012 through January, 2013 to evaluate adherence to policy. The following criteria were assessed: 1) submission at least 3 days in advance of scheduled treatment, 2) reference provided, 3) approval by clinical director and pharmacy, 4) order written as “Exception order,” and 5) reimbursement of high cost drugs without NCCN support (category 1 or 2A). Drugs evaluated for reimbursement included: bevacizumab, cetuximab, albumin-bound paclitaxel, rituximab, trastuzumab, liposomal doxorubicin, ipilimumab, brentuximab, bendamustine, and bortezomib. Data were also collected from electronic order entry reports, eMARs and hospital billing systems. Results: A total of 83 off-label requests were submitted and reviewed over study period. The majority of requests were written as “Exception orders” representing 2.1% of overall cycle 1 orders. Ninety-eight percent of requests were approved; 40% of requests fully met off-label policy criteria; 28% of requests were submitted without 3-day advance notification; of these, 57% were requested on day of scheduled treatment; 30% of requests were submitted without a reference. Thirty-three claims were evaluated for reimbursement; 91% were paid. Bevacizumab (n=22) was the most commonly requested high cost drug. Conclusions: Providers are generally adhering to the off-label policy. Opportunity exists to improve full adherence. This will ensure adequate time for pharmacy and finance review and avoid unnecessary delays in patient care. The majority of claims for high cost drugs were paid.
Improving quality of cancer care by rapid adoption of new scientific evidence.
Authors: Schottinger Joanne , Rabrenovich Violeta , Campen David , Fredriks Dean 
Published: February 2017

62 Background: The goal of the Kaiser Permanente (KP) Cancer Care Program is to provide patient-centered, evidence-based, safe care for all KP oncology patients. Multiple processes and information technology tools support KP’s clinicians in delivering the best care to our patients. Prior to 2008, chemotherapy ordering and administration across KP was paper-based, and the standardization of chemotherapy regimens was driven by prescribers’ preferences. KP Oncologists used more than 1,400 chemotherapy protocols. Pharmacy had varying systems for dosing alerts, and reliable chemotherapy administration data was not available for clinical quality improvement. Methods: By 2012, all KP regions had implemented the KP HealthConnect Beacon (KPHCB) system, which incorporates chemotherapy ordering, alerting, verifying, dispensing, and administration in ambulatory and inpatient settings. Important outcomes of the KPHCB implementation include: 1) our success in gaining agreements on standardization of chemotherapy protocols across the Program, and 2) implementation of a rapid process for adoption of new scientific evidence. Our approach includes an evaluation of the quality of the relevant scientific literature and an assessment of a particular treatment. The KP multidisciplinary team discusses and integrates the scientific evidence and clinical expertise of KP clinicians into KPHCB chemotherapy protocols. The new evidence-based protocols with supporting literature references are imbedded as a web link at the end of the each protocol and are available to clinicians within days following the publishing of new evidence. Results: An example of a rapid dissemination and adoption of evidence is the 2010 Pfizer’s and FDA’s announcement that the sale of Mylotarg would be voluntarily discontinued due to a fatal liver veno-occlusive disease. Within 48 hours, we identified 12 patients who received Mylotarg in 2010, and the treating oncologists were individually contacted and provided with the new information to discuss with patients, as appropriate. Conclusions: The benefits of KP’s rapid adoption of new evidence methodology are reaching over 40,000 cancer patients, receiving over 250,000 chemotherapy treatments annually.
Clinical process analysis: Embedding performance improvement skills for measurable and sustainable change.
Authors: Hayes Beverly A , Barnes Courtney , Aranzamendez Gina , Kaufman Laurie , Haywood Valerie , Rohe Duke 
Published: February 2017

67 Background: The Clinical Process Analysis methodology, based on Time Driven Activity Based Costing (Kaplan), aligns data reporting with frontline processes to drive improvement in clinical quality and financial performance. After the completion of 6 ambulatory centers (with 6 in progress), the program evolved to include a Performance Improvement (PI) Phase. The goal: embed PI skills in all clinical operations; provide resources for PI project initiation, facilitation, and sustainability; and continue collaboration with MD Anderson Cancer Center process owners through measurable improvement in safety, timeliness, effectiveness, efficiency, equity and patient-centeredness. (IOM 2001). Methods: The center and the CPA Team utilize institutional dashboards and multiple data resources to establish the project scope. The scope is converted to a Blueprint which outlines a timeline of the project, a list of required resources, and center-specific data. The CPA Team interviews frontline staff, clinical leadership and financial teams to create a current state process flow chart. Opportunities for Improvement (OFI), operational and clinical variations, cycle times and other management reporting metrics are included on the charts, as well as patient experience audio, as gathered by an MD Anderson marketing team. OFIs are evaluated, categorized, and prioritized by clinical leadership, and the CPA Team works with the center’s designated PI team to develop and implement Quick Fixes, PDSA and more extensive projects. Results: In 6 completed ambulatory centers in FY13: 176 Opportunities for Improvement, $936,463 Savings. Summary reports provide direct labor costs and estimated times, per resource type, for center activities. Per MDs, managers, staff and financial experts, other uses for process flow charts include: tracking patient flow; resource utilization; customer satisfaction; patient education; and on-boarding staff. Conclusions: In FY14, the CPA Program will focus on patient access in 15 centers, gathering data to identify trends and common themes to implement Best Practices across the institution.
Sharing hope: Preserving fertility through partnership.
Authors: Rechis Ruth , Eargle Emily , Arvey Sarah R. , Nutt Stephanie , Koenings Ashley , Hemingway Bree 
Published: February 2017

69 Background: Each year about 70,000 individuals aged 15-39 are diagnosed with cancer. Unfortunately, essential cancer treatments often negatively impact an individual’s fertility. The average cost of fertility preservation ranges upwards of $12,000 for women and $1,500 for men and most insurance companies typically do not cover pre-treatment fertility preservation. Not only do these individuals experience a life-threatening cancer diagnosis, they are also faced with the possibility of not having children of their own in the future. The LIVESTRONG Foundation’s Fertile Hope Program provides educational information and timely pre-treatment financial assistance to cancer survivors whose medical treatments present the risk of infertility. Female participants receive the medication at no cost through the Foundation’s partnership with EMD Serono, and all survivors can receive at least a 25% discount, on preservation services at the more than 350 partnering fertility clinics. Methods: LIVESTRONG Navigators implementing this program track all interactions on an ongoing basis. Additionally, in 2012, clients who had been approved for the program within the last 12 months and those who had been approved two or more years ago received an online survey (N=200 and 105 respondents respectively). Results: In 2012, 3,353 individuals (1,537 men and 1,816 women) saved a total of $12,542,114 through this program. Survey respondents indicated that they value the speed of the process and the opportunity to preserve their fertility. Interestingly, respondents noted that they learned about the program through a reproductive doctor, but they learned about fertility-related issues through an oncologist. Finally, respondents indicated that 14 babies have been born as a result of this program. Conclusions: This program has made a unique and measurable change to improve the quality of life of survivors. By providing information and support as well as reducing costs, survivors have the potential to fulfill their aspirations to bear a biological child. Ensuring that providers who share information about fertility-related issues are informed about these types of programs could help to ensure all interested survivors have access to discounted, timely fertility preservation.
Quality assurance governance and implementation in cancer pathology: A national survey of Canada.
Authors: Mitera Gunita , Srigley John , Geldenhuys Laurette , Trotter Martin , Magee Fergall , Ravinsky Esther , McLachlin Meg , Banerjee Diponkar , Têtu Bernard , Carter Beverley , Rahmeh Tarek , Henderson Rosemary 
Published: February 2017

73 Background: Robust quality assurance (QA) programs incorporating both technical and interpretive aspects of QA are integral to accurate pathology diagnosis and quality of care a cancer patient receives. Programs and governance addressing technical pathology quality have been well developed in Canada and internationally. The extent of interpretive pathology QA implementation across Canada remains unknown. The objective of this study was to document the current landscape for pathology QA in Canada. Methods: An environmental scan was conducted to determine the types and extent of current large institution and provincial-level pathology QA programs in place across Canada. An electronic survey was administered to key stakeholders and senior decision makers in cancer pathology. Targeted interviews were conducted with pathology leaders in each province to verify survey results, deliberate and resolve ambiguous responses. Results were presented to all survey respondents as a feedback mechanism. Results: 9/10 provinces currently have a professional group representing pathologists. 10/10 provinces currently have a technical QA program. Of these, 2/10 provinces are governed through Accreditation Canada, 3/10 provinces are governed through the Ontario Laboratory Accreditation Program and the remaining 5/10 provinces are governed by separate provincially-led programs. For interpretive pathology QA, 2/10 provinces have a coordinated provincial interpretive QA program, 5/10 provinces do not have provincial coordination, and have plans to implement one, and 3/10 provinces do not have a provincially coordinated interpretive QA program in place, nor are they planning to develop one. Conclusions: This is the first study to document the provincial landscape for pathology QA in Canada. Large pan-Canadian variations remain for level of integration and future plans to develop and integrate interpretive pathology QA programs within provinces. Next steps should include the development of a pan-Canadian recommendations framework for interpretive pathology QA to help guide senior decision-makers in implementing such quality programs provincially.