bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathway map development as an approach to identifying priority areas for quality improvement in Ontario.
Authors: Mackay Helen , Soobrian Jasmin , Murphy Joan , Elit Lorraine , Milosevic Michael F. , Gollnow Angelika , Ross Jillian , Holloway Claire ,   Cancer Care Ontario (CCO) Cervical Care Pathway Working Group
Published: February 2017

108 Background: Disease Pathway Management (DPM) is the unifying approach to the way in which Cancer Care Ontario (CCO) sets priorities for cancer control, plans cancer services and improves the quality of care in Ontario. In 2014 DPM began developing a cervical cancer pathway map (CCPM) to map the patient journey along the cervical cancer care continuum. Objective: to report on the CPPM development process as a tool to identify key priorities for cervical cancer management in Ontario. Methods: DPM convened a multidisciplinary/multi-stakeholder cervical cancer working group with regional and specialty representation from across Ontario. Over 12 months, 33 individuals participated in an in-person meeting and monthly teleconferences. The CCPM was drafted using guidelines developed by CCO’s Program in Evidence Based Care (PEBC) and considering clinical guidance documents from several jurisdictions. Throughout the development process the team were asked to discuss and reach consensus on key priorities for improving care. Results: Twenty-two priority areas were identified across the continuum in: prevention, diagnosis, treatment, follow-up and survivorship. Opportunities were identified for: development/endorsement of evidence based guidelines; patient-centered approaches to screening; quality improvement; survivorship; drug funding implementation and a CPPM Knowledge Translation strategy. Potentially actionable items were aligned with relevant internal and external stakeholders including organized screening programs, the PEBC, provincial drug reimbursement programs and other quality improvement teams within CCO. Conclusions: The process of bringing multidisciplinary experts together in order to develop the CPPM successfully identified key priorities across the spectrum of care in Ontario and allowed identification of potential opportunities for quality improvement, development of practice guidelines and new models of care. In turn, the CCPM provides a patient-centred disease focused framework from which stakeholders can approach and evaluate new initiatives in the context of the cervical cancer continuum.
Optimizing the collection and reporting of wait time data.
Authors: Bedford Colleen , Langer Deanna , Kaan Melissa , Norton Jonathan , Ho Brian , Thomas Ann , Dobranowski Julian 
Published: February 2017

121 Background: Wait times for critical interventional radiology (IR) procedures have long been reported as barriers to access for cancer patients. Wait times have been difficult to measure in the province of Ontario as no mechanisms exist to capture IR data. Three individual programs at Cancer Care Ontario (CCO) began collection of CT-guided biopsies wait time data, with nuances dependent on program area of focus. The Cancer Imaging Program collects appointment availability for lung biopsies through a monthly email survey. The Diagnostic Assessment Program collects patient-level lung biopsy data at select facilities in the province. The Access to Care program collects patient-level data from facilities that perform CT biopsies, but the data is not specific to lung biopsies. To streamline data collection processes and provide a comprehensive report for the province, the three programs are collaborating to validate current data sets and optimize data collection. Methods: A four phase approach has been developed to prepare for the ongoing comprehensive report: Planning – identify target audience, timelines, and data; Data Validation – three step evaluation to compare data sets; Test Report – consultation of draft report with clinical experts; and Evaluation – lessons learned from steps one to three to prepare for ongoing report. Results: This initiative allows each program to: Critically assess the components of their respective datasets; Cross-validate data for consistency or alignment; and Frame the clinically relevant data components to support and inform decision making and reporting processes. Through this process, efficiencies are gained by streamlining data collection and ensuring alignment between program areas. The collaborative approach ensures the business needs of each program are protected in the final product. Furthermore, this process will allow decision makers at CCO to analyze various methods of wait time data collection and aid in methodology decisions of future collections. Conclusions: The final product of this initiative will provide physicians and decision makers throughout Ontario with robust data to understand what is happening in their hospitals. The report will also facilitate impact analysis of interventions to reduce wait times.
Clinical specialist radiation therapists (CSRT): Creating capacity while improving quality of care.
Authors: Lockhart Elizabeth , Ang Michelle , Zychla Laura , Bak Kate , Nagata Lynne , Beglaryan Hasmik , Ross Jillian , Husain Asad , Simniceanu Carina , Gutierrez Eric , Warde Padraig Richard , Harnett Nicole 
Published: February 2017

124 Background: Ontario’s cancer system faces many challenges, including a rising incidence of cancer, aging population, increasingly complex cancer treatment, and health human resource (HHR) constraints. In response, Cancer Care Ontario and the Ontario Ministry of Health and Long Term Care collaborated on a project to assess whether a new advanced practice radiation therapist role – the ‘Clinical Specialist Radiation Therapist’ (CSRT) – could enhance access to high quality, innovative care by optimizing the use of HHR. Methods: This innovative model of care aims to enable radiation therapists with advanced training and accreditation (CSRTs) to assume responsibility for certain activities traditionally performed by radiation oncologists (ROs) while maintaining and improving the quality, accessibility and efficiency of radiotherapy (RT) for patients. To assess CSRTs’ impacts standardized metrics, including efficiency (access, wait times (WTs), team function) and quality (new/enhanced services, patient experience) measures, were used. Results: Currently there are 24 CSRTs in 9 of 14 regional cancer centres. 2014/15 data demonstrated that CSRTs can improve the efficiency of referral processes and clinic operations, decrease WTs, and increase capacity (2-28 additional patients seen in clinic/month). Optimized team function and time savings (5-66 RO hours/month) have been achieved through CSRTs’ assumption of certain patient assessment and treatment planning activities. Efficiencies have improved patient experience by facilitating quicker, more coordinated flow through the RT process, and greater continuity of care. Further, CSRTs have enhanced access to high quality RT, through > 75 innovative initiatives (rapid access clinics, telemedicine consults). Conclusions: The CSRT role demonstrates how innovative models of care can improve patient access to high quality cancer care. With 24 CSRTs implemented, opportunities for analysis of factors which facilitate achievement of maximal impact and position sustainability exist. Such investigations could inform the refinement and further implementation of CSRTs in Ontario and other jurisdictions, improving patients’ access to RT more broadly.
Timeliness of care delivery for lung cancer patients in a vertically integrated health care system.
Authors: Cooper Robert Michael , Hahn Erin Elizabeth 
Published: February 2017

127 Background: A Kaiser Permanente Southern California (KPSC) organizational goal is to achieve optimal timeliness of cancer care delivery. The purpose of this report is to present a process used for a multi-disciplinary physician led performance improvement exercise at the at the Los Angeles Medical Center and share initial learnings. Methods: A CME approved Performance Improvement (PI) program to examine timeliness of care delivery for newly diagnosed patients with lung cancer was created for physicians. The multi-disciplinary core group met for 6 three hour blocks of time to process map the patient centered flow. The physicians evaluated current practice, developed a future state and made structural changes. The group focused on two time intervals: time from suspicion of malignancy until pathology resulted, and time from pathology until the start of treatment. Results: Initial learnings included, that the work was meaningful as shown by physicians using their dedicated education time and consistency of participation; an electronic medical record was useful for the initial process mapping and ongoing monitoring; patient flow is complex and patients followed many different paths to diagnosis and treatment. Participating in this project benefitted team building, improved understanding of the challenges throughout the system, enhanced empathy for their colleagues and patients, and educated physicians about performance improvement methodology. Preliminary review of timeliness of care delivery shows improvements in timeliness at the two time points both during the year of instituting a PI program and with the first interventions. Conclusions: A physician led multi-disciplinary approach to review of timeliness of care delivery is feasible and productive.
Early experience with Puerto Rico: Effective use management of bone agents.
Authors: Wurtz Kenneth , Huff Dinah Faith Q. , Feliciano Lourdes , Bennett Charles L. , Knopf Kevin , Hrushesky William J. , DiMarco Anna , Baum Michael 
Published: February 2017

130 Background: Oncology Analytics is a cancer care decision support group recently entering the Puerto Rican cancer care marketplace. Bone agents are used in metastatic cancer management to delay the progression of lytic bone metastases. These agents are also used for the treatment of demonstrated osteoporosis with bone densitometry (DEXA scan). Oncology Analytics has found these agents are sometimes used in the absence of lytic metastases or osteoporosis. When this is discussed with treating physicians, practice patterns promptly improve. Beginning our work: The following work focuses entirely upon use among patients with bone mets. There is modest use of bone agents for bone mets among PR oncologists. A statistically significant decreasing and sustained trend in the inappropriate utilization of bone agents and especially the use of denosumab in the PR market is closely associated with recent initiation of OA decision support. Methods: We analyzed data from oncology drug preauthorization requests for bone modifying agents for the management of metastatic bone disease submitted by providers to payers serving in Puerto Rico from Jan 1, 2015 through September 30, 2015. Results: Within the 9 months, non-compliant zoledronic acid use diminished by one-third; pamidronate by 40%; and denosumab use was decreased by 75%. Quarterly dynamics demonstrates a statistically significant downward trend in the unnecessary use of these agents among PR oncologists (p,0.05). Conclusions: Oncology Analytics presence in a new market enhances cancer care quality and cancer care value quickly, while at the same time conserving substantial resources.
Multidisciplinary process improvement to optimize oral chemotherapy safety.
Authors: Amport Stephanie Buia , Adelson Kerin B. , Fradkin Monica , Havriliak Renee , Harrison Michelle Renee , Abdelghany Osama , Kregling Stephanie , Wright Jessica , Morrow Bret , Sterling Roberta , Smith Mandeep , Esposito Frank , Stutsky Martha , Miller LeeAnn , Lilenbaum Rogerio , Lyons Catherine A. , Chiang Anne C. , Cohen Howard 
Published: February 2017

134 Background: The rapid development of oral chemotherapy agents brings unique challenges. These drugs must be treated with the same vigilance as parenteral chemotherapy. The oral chemotherapy system is not optimized or integrated across our hospital. A quality assessment survey identified the need for a better means to monitor and improve oral chemotherapy patient outcomes. Methods: Patient and staff satisfaction with the current process was measured. A chartered multidisciplinary task force reviewed existing practice and developed a program to identify patients, ensure drug access, standardize prescription and consent, ensure on-going clinical support including patient education, regimen specific adherence monitoring, toxicity assessment and address patient concerns. Current state process mapping and gap analysis identified eighty-seven points where care could break down. A risk mitigating model was developed to include clinically reviewed electronic orders, nursing and pharmacist order review, specialty pharmacy, Medication Assistance Program (MAP) to assist with access and co-payment, patient education, day 5 and 21 pharmacist to patient phone calls, multidisciplinary flow sheet documentation, EMR report to track patients and outcomes and standardized patient education and provider training. The implementation team addresses process challenges identified via clinical team feedback e.g. therapy delays and implements fixes. Results: See table below. Specialty pharmacy revenue is directed to supporting non-profit clinical care at a time when revenue sources are being cut. MAP co-pay support exceeds $2.3 million. Conclusions: A patient-centered multidisciplinary care model integrating clinical, operational, financial and technology resources optimized care. Our improvement approach created opportunities for collaboration between pharmacists, physicians and nurses and can be adapted for many settings. [Table: see text]
Enhancing a culture of patient safety in an oncologic hospital setting.
Authors: Worthington Nicole , Bristow Shannon 
Published: February 2017

135 Background: Patient safety is a priority for all hospitals and staff members. With approx. 1:10 hospitalized patients experiencing an adverse event1, healthcare lags behind other industries with regards to safety. Oncology patients have an increased risk of adverse events due to an immunocompromised status, coupled with complex treatments. Cancer Treatment Centers of America at Eastern Regional Medical Center (ERMC) recognized the need to heighten patient safety while maintaining a positive patient experience. Methods: ERMC participates in the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture to assess employee’s perception of the organization’s patient safety, conducted every 18-24 months. The most recent survey was conducted between May 11 - June 1, 2015. Interventions to enhance safety culture from 2013 to 2015 survey results included: daily safety check-ins for all hospital departments for both day and night shifts; sharing safety stories before routine meetings; leadership rounding; and enhanced transparency of safety events that occurred throughout the hospital. Routine in-servicing was also completed to educate staff members on reportable safety events for Pennsylvania and foster ongoing discussions about patient safety. Results: Survey response rate experienced a 236% increase from 2013 to 2015 (218 to 628 responses respectively). Of the 12 patient safety composites, 11 showed an increase in scores from 2013 to 2015, the outlier being “overall perceptions of patient safety” composite score which dropped by two percentage points. Furthermore, ERMC was above the national benchmark in all 12 patient safety composite categories for the 2015 survey. Conclusions: The ERMC staff considers safety a priority, as evidenced by the increase in AHRQ survey scores from 2013 to 2015. Perceptions of safety throughout the system have increased with the initiation of several safety projects. Based on raw comments from the AHRQ culture of safety survey, more work is needed to involve non-clinical staff in hospital safety. Moving forward, ERMC will investigate innovative solutions to involve all staff, clinical and non-clinical alike, to be engaged in patient safety.
Moving towards hospital and radiation oncology EMR integration: Results of an institutional survey.
Authors: Solanki Abhishek Ashok , Surucu Murat , Kaczmarz Barbara , McCoo Teresita , Roeske John , Small William 
Published: February 2017

152 Background: We are working to electronically integrate our radiation oncology EMR and our hospital EMR to improve communication and facilitate patient care. To guide integration, we surveyed providers and support staff at our academic cancer center to identify the important encounters/documents and how well these are currently communicated. Methods: We sent an email survey to 182 MDs, nurses, and administrative staff at our cancer center. Respondents identified their role in the patient care team, and rated how important several radiation oncology-specific encounters/documents from “not important at all” to “extremely important” and rated the accessibility of these encounters/documents from “not at all accessible” to “exceptionally accessible.” Encounters/documents are listed in the table. Descriptive statistics were then performed to identify opportunities to improve communication. Results: There were 32 responses to our survey from staff outside of our department, including 18 physicians, 2 APN/PAs, 8 nurses, 2 nutritionists, 1 receptionist, and 1 social worker. Of the physicians, there were 8 medical oncologists, 2 neurosurgeons, 5 urologists, 1 breast surgeon, 1 gynecologic oncologist, and 1 reconstructive surgeon. The table describes the number of respondents who felt the encounter/document was “moderately,” “very,” or “extremely important”, and within this group of respondents, what percent thought each item was “very” or “exceptionally accessible.” Conclusions: We prioritized the importance of encounters/documents for integration between EMRs and identified deficiencies in communication. We will use the results of this study to guide our electronic integration of our two EMR systems. We will repeat the survey after integration is complete to identify improvement. [Table: see text]
Survival as a measure of quality of cancer care and advances in therapy: Lessons learned from analyses of the National Cancer Data Base (NCDB).
Authors: Shulman Lawrence N. , Palis Bryan E. , McCabe Ryan M. , Gay E. Greer , Mallin Katherine , Loomis Ashley , Winchester David P , McKellar Daniel P. 
Published: February 2017

173 Background: Many quality metrics of cancer care are process measures, based on whether a patient received recommended treatment for diagnosis and stage of their disease. Survival is dependent on patient characteristics, disease specifics, and care received (surgery, systemic therapies, radiation). Some argue survival is the ultimate measure of cancer care quality. Survival calculated from registry data may be a better indication of the real effects of new therapies as it contains a broad representation of patients who may not meet the eligibility criteria for clinical trials. Methods: The NCDB is composed of registry data from approximately 1,500 hospital based cancer programs, and includes stage, demographic data, co-morbidities, treatments, and vital status. Survival analyses were derived from NCDB data for all stages of breast cancer, non-small cell lung cancer (NSCLC), and pancreatic cancer. These diseases were selected because breast cancer has a high survival rate, whereas NSCLC and pancreatic cancer are diseases with a poor prognosis, but recent advances may have improved survival. Un-adjusted and risk adjusted survival were analyzed by socioeconomic, tumor, and hospital factors including stage, comorbidities, diagnosis year (to assess new treatment trends), and type of institution (academic, comprehensive community, and community cancer programs). Results: Results for these diseases and variables noted will be presented. Whereas better un-adjusted survival rates were often seen at academic cancer programs, differences disappeared after risk-adjustment. Improved survival was seen in more recent years, probably representing new treatment effects, though gains were modest and stage dependent. Conclusions: Measuring survival across hospitals and regions is critical to understanding the state of cancer treatment nationally and the effect of quality and therapy advances on patients across a variety of clinical settings. Methodologic challenges in analyzing and interpreting survival data must be realized, and continued innovation in the collection and analysis of data is needed.
Patient preferences for provider roles in collaborative breast cancer survivorship care.
Authors: Wallner Lauren P. , Abrahamse Paul , Friese Christopher Ryan , Katz Steven J. , Hawley Sarah T. 
Published: February 2017

184 Background: Prior studies have exploredbarriers to collaborative cancer care and suggest a need for greater clarity about clinician roles. However, little is known about patient’s preferences and expectations for which clinicians handle various aspects of care after primary cancer treatment. Methods: A weighted random sample of newly diagnosed breast cancer patients in the Georgia and Los Angeles SEER registries were surveyed approximately 6 months after diagnosis (expected final N = 2600, 70% current response rate). Patient preferences for which clinician handles the following aspects of care after treatment were ascertained: follow-up mammograms, screening for other cancers, general preventive care, treatment of comorbidities, physical symptoms, emotional symptoms, and reassurance about their breast cancer. Response categories included primary care clinician (PCP), cancer doctors, either or both. The associations between patient demographic and clinical factors with preferences for clinician roles were assessed using multinomial logistic regression. Results: In a preliminary sample (N = 1038), the majority of women preferred to see oncologists for mammograms (63%), other cancer screening (67%) and reassurance about their cancer (75%) and PCPs for general preventive care (80%), comorbid care (85%) and emotional symptoms (67%). Black women (vs. White) were more likely to prefer to see both clinicians for mammograms (OR: 3.7, 95%CI: 2.5, 5.5), screening for other cancers (OR: 2.1, 95%CI: 1.3, 3.2), reassurance about their cancer (OR: 2.1, 95%CI: 1.3, 3.2), and general preventive care (OR: 4.0, 95%CI: 2.1, 7.8). Black and Hispanic women were more likely to prefer to see both for comorbidity care (Black OR: 3.2, 95%CI: 1.6, 6.3; Hispanic OR: 2.6, 95%CI: 1.1, 6.3). Less than a high school education was also associated with a preference for seeing both clinicians for comorbidity care. Conclusions: While patients report clear preferences for which clinicians handle various aspects of their collaborative survivorship care, variation exists by race and education. Targeting these patients to clarify clinician roles may be particularly effective in interventions to improve collaborative cancer care.