bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cancer registry-survey data linkages to measure patient-centered quality of care: SEER-MHOS and SEER-CAHPS.
Authors: Kent Erin E. , Mollica Michelle , Gaillot Sarah , Halpern Michael T. , Hays Ron D. , Lines Lisa M , Topor Marie A. , Yuan Gigi , Schussler Nicola C. , Ramirez Edgardo , Wilder Smith Ashley 
Published: February 2017

303 Background: Limited opportunities exist to conduct population-based surveillance of cancer patient-reported outcomes. Data from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program has recently been linked with data from two Centers for Medicare & Medicaid Services quality improvement surveys: the Medicare Health Outcomes Survey (MHOS) and the Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. We provide an overview of the data available, recent findings, and priority areas for future research. Methods: Since 1998, the MHOS has conducted 2-wave/biennial surveys of individuals ages 65+ and individuals with disabilities enrolled in Medicare Advantage (MA) health plans on aspects of health-related quality of life, functional status, comorbidities, and symptoms. Fourteen cohorts are available, representing over 126K patients with cancer and over 1.9 million MA enrollees without a history of cancer. The SEER-MHOS publicly available data resource has produced over 40 data use agreements and 19 publications. SEER-CAHPS links cancer registry data with cross-sectional survey data of Medicare beneficiaries (both fee-for-service and MA) that contain information on patient experiences with care, including access to needed and timely care, doctor communication, health plan customer service, and care coordination. The current linkage contains survey data from 1998 to 2010 and includes over 150K and 570K respondents with and without a history of cancer, respectively. Plans to launch the publicly available resource are underway. Results: Recent findings include the impact of diagnosis and treatment on health-related quality of life in older cancer survivors, physical health impairments and variation of treatment received, the impact of cancer on activities of daily living, and variations in care ratings between participants with and without cancer across the cancer control continuum. Conclusions: The SEER-MHOS and SEER-CAHPS linked data resources provide population-based surveillance data on cancer patient-reported outcomes which allow unprecedented opportunities to evaluate national quality improvement activities.
First-line treatment of metastatic NSCLC (mNSCLC) patients without actionable mutations in U.S. community oncology clinical practice.
Authors: McKay Caroline , Arunachalam Ashwini , Burke Thomas A. , Cao Xiting , Abernethy Amy P , Carbone David Paul 
Published: February 2017

307 Background: Benchmarking high quality care requires defining optimally effective practice patterns. As first step, contemporary real-world practice must be detailed. The purpose of this study is to describe patient flow from diagnosis of mNSCLC to initiation of anti-cancer drug therapy in patients without known EGFR/ALK genomic tumor aberrations; the characteristics and first-line (1L) anti-cancer treatment of these patients, including induction and maintenance therapy. Methods: Retrospective database cohort study using data from an oncology EHR system, representing 17% of incident cancer cases from US community setting. Study population includes patients diagnosed with stage IV mNSCLC treated between 11/ 1/12 and 1/31/15 with follow-up to 7/31/15. Treatment patterns include regimen, number of doses, and time to regimen discontinuation. Data are analyzed descriptively, for overall cohort and by histology, with time to treatment discontinuation analyses using the Kaplan Meier method. Results: Of 4441 patients with mNSCLC, 88% had EGFR/ALK negative or unknown status. Of 79% who initiated 1L therapy, 69.5% (n = 2014) of patients (78.4% non-squamous, 21.7% squamous) were included. 55.1% were men; 89.8% were age 65+. 83.4% received induction therapy only; 16.6% received induction and maintenance therapy. 85% received a platinum combination as induction therapy; the majority either received a carboplatin doublet (53.5%) or carboplatin doublet in combination with targeted therapy (23.3%). 14.4% received a non-platinum based regimen. During induction therapy only, mean duration for the most common regimen category (platinum based combination) was 96.9 (IQR 43-129) for squamous and 79.45 (IQR 36-108) days for non-squamous patients. Of non-squamous patients who received induction followed by maintenance, mean duration of therapy was 103.9 (IQR 66-134) and 140.7 (IQR 45-208) days for induction and maintenance, respectively. Conclusions: Results describe treatment patterns in the US community 1L setting, prior to introduction of anti-PD1/PD-L1 inhibitors and new angiogenesis inhibitors. These form a starting point for benchmarking high quality care in mNSCLC.
The impact of guideline treatment nonadherence on survival for colorectal cancer patients: Propensity score calibration via a validation cohort.
Authors: Hines Robert Brooks , Lai Sue Min , Baranda Joaquina Celebre , Engelman Kimberly K. , Dong Frank , Bayakly A. Rana , Collins Tracie 
Published: February 2017

308 Background: The quality of cancer care has been the focus of ongoing concern for cancer researchers, providers, and policy makers. The objectives of this study were: 1) to evaluate nonadherence with National Comprehensive Cancer Network treatment guidelines for colorectal cancer (CRC) patients and the impact on survival, and 2) to obtain error-corrected estimates of effect by means of propensity score calibration via a validation cohort. Methods: CRC patients identified by the Georgia Comprehensive Cancer Registry for the years 2000-07 were eligible (N = 18,388). Naïve propensity score (PSn) adjustment and PS calibration (PSC) via a validation cohort were utilized to obtain hazard ratio estimates for the impact of guideline treatment nonadherence on 5-year overall survival. The validation cohort contained additional information on comorbidity and payer status which was used to obtain error-corrected estimates of effect by PSC. Results: Treatment nonadherence conferred a large increased risk of death early in the follow-up period which declined over time (Table 1). Comparison of results from the PSn and PSC models indicated moderate to large bias due to unmeasured confounding in the PSn model (data not shown). Conclusions: PSC produced attenuated estimates and had an impact on study conclusions in the latter follow-up period. For CRC patients, health services research into the quality of care received by cancer patients is necessary to continue the improving trend in CRC-related mortality. [Table: see text]
Regional initiative to use data transparency to improve cancer care.
Authors: Kreizenbeck Karma L. , Fedorenko Catherine R. , Hoopes Teah , Lyman Gary H. , Brown Thomas David , Chen Eric Y. , Conklin Ted , Corman John M. , Lonergan Matt , Lessler Daniel , Martins Renato , Mera Csaba , Rieke John Whitelaw , Saikaly Elie P. , Smith Julie C. , Stewart F. Marc , Whitten Richard , Ramsey Scott David 
Published: February 2017

39 Background: In the context of many initiatives aimed at measuring quality and value in cancer care, the Hutchinson Institute for Cancer Outcomes Research (HICOR) has adopted a multi-stakeholder approach to characterize oncology care, prioritize areas for improvement, design programs, and evaluate outcomes. Beginning in 2014, HICOR initiated a process to move towards data transparency in the reporting of regional quality and value metrics. Methods: The HICOR team constructed clinic-level adherence reports for community-prioritized metrics and the 2012 ASCO Choosing Wisely recommendations using a registry-claims linked database. In the fall of 2014, a national external advisory board reviewed methodology for measuring adherence. De-identified regional results were presented at a provider meeting in late 2014 to elicit provider feedback on methodology and on strategies for reporting clinic-identified adherence. Clinics were privately given their own adherence data. In 2015, revised de-identified regional reports were presented at a Value in Cancer Care Summit poster session and made available through HICOR IQ, a regional oncology informatics platform, for further discussion. Results: Results show that no clinic was also the best or worst performing clinic. The table shows the performance by clinic for the 5 Choosing Wisely recommendations. There is now increased demand by clinics to view their own adherence benchmarked with the region as a next step in moving towards full data transparency. Additionally, there is support from provider members in the community to re-identify clinics in order to compare results against their peers. Conclusions: Using an iterative, transparent, multi-stakeholder process, it is feasible build regional consensus towards releasing clinic-level adherence to quality and value metrics. By consulting trusted experts in the field and allowing multiple opportunities to provide feedback, providers are requesting even more transparency in order use the oncology measures to improve care in their practice and the region. [Table: see text]
What is needed to implement Institute of Medicine (IOM) 2013 supportive oncology recommendations in community settings?
Authors: Trosman Julia Rachel , Berardi Rosa , Weldon Christine B. 
Published: February 2017

49 Background: The IOM 2013 report recommends supportive oncology services from diagnosis through survivorship and end of life. We examined what community institutions need to implement IOM recommendations. Methods: Survey of 35 institutions in a urban area (13 cancer centers; 14 cancer support centers, 8 hospices). Institutions ranked the top 5 supportive oncology project ideas, that their organization was most interested in participating in, from a list of 27. Results: Survey response rate was 100%. Respondents agreed on 8 of top 10 priorities across the three organization types (Table). Local inter-institutional collaboration leveraging respective resources and facilitating care consistency across sites was the most frequently need. It was followed by the need for stratified care processes based on patient need and improved supportive oncology reimbursement. Priorities differed between Cancer Centers and other institution types on Consolidated screening tools* (p = .05, .09) and Care process for family / caregiver** (p = .006, .04). Conclusions: Supportive oncology care processes and tools are needed to implement IOM recommendations in the community. Our findings inform a roadmap for practical collaborative implementation of the IOM recommendations. Differing priorities across cancer institution types should be further explored and addressed within the roadmap. [Table: see text]
Treatment prices at the point of care: Pilot.
Authors: Henrikson Nora B , Lau Rebecca W. , Tuzzio Leah , Christianson Matthew Alan , Chen Eric Y. , Phan Thanh-Hien 
Published: February 2017

4 Background: People with cancer increasingly wish to discuss cancer care costs with clinicians. In our organization all price questions go to a central customer service line with limited capacity to address oncology-specific questions. We aimed to improve clinician access to treatment prices to assist them in responding to patient concerns about prices. Methods: We developed, launched, and evaluated a pilot tool and accompanying workflow for four oncology clinics in an integrated delivery system in WA. The online tool included a series of 50 printable worksheets for the most commonly ordered cancer treatment protocols accessible directly from the electronic health record. The worksheets included codes and prices for all drugs, supportive medications, tests, and professional services for one treatment cycle presented in patient-friendly language. We audited the accuracy of the cost information against patient bills. The worksheets did not provide patient-level cost-shares. We evaluated the resource’s launch, initial use, and acceptability through a convenience survey of initial users. Results: The project was successfully launched. Initial web traffic to price sheets exceeded the number of treatments being ordered during the launch period. A third of survey respondents (33%) reported using the cost sheets at least once a week. Reported most useful features were improved access to cost information, treatment protocol-based layout, and the service of previously unmet patient needs. Seventy percent (70%) reported that the resource had no impact on their workload. The mean value of the resource (1 lowest and 10 highest value) was 7.9 (value to patients); 7.8 (to oncology service line), 7.7 (to Group Health) and 6.5 (to own work or practice). Staff reporting of patient response was generally positive. Suggested improvements included provide patient-level cost share (63%) followed by expanding the project to include more protocols (33%). Conclusions: The pilot was feasible, built capacity to locate price data, and did not adversely impact staff workload. It addressed a clear need and demonstrated high potential overall value, especially its protocol-based format. The resource’s lack of personalized estimates of out-of-pocket charges was the biggest gap reported.
Identifying avoidable terminal oncology ICU hospitalizations.
Authors: Daly Robert Michael , Hantel Andrew , Polite Blase N. 
Published: February 2017

56 Background: Eight percent of cancer patients expire in the ICU. There is no association between spending on aggressive end of life (EOL) care and survival outcomes. This aggressive care is also associated with reduced quality of life for patients and families. The National Quality Forum endorses the number of patients admitted to the ICU in the last 30 days of life as a quality of care measure. Our hypothesis is that a significant number of oncology patients suffer avoidable terminal ICU hospitalizations. Methods: Using data from the University of Chicago (UCM) Cancer Registry, we identified patients who died in UCM adult ICU’s in FY2013. Of the 1,388 oncology deaths, 115 were in the ICU. Of those, 72 were established patients having had at least one visit with a UCM oncologist. A physician from oncology, critical care, and hospital medicine directly reviewed the electronic medical record of each patient from 3 months prior to index hospitalization until death. Using a standardized assessment tool, these physicians then determined whether the terminal hospitalization was clinically avoidable through different medical management. The primary outcome was the proportion of terminal oncology ICU hospitalizations identified as potentially avoidable by two or more reviewers. Results: Seventy-one percent of this patient population had a solid malignancy and 53% of those had metastatic disease. The ECOG performance status was ≥ 2 prior to admission in 51% of patients. Eighty-two percent had at least one prior hospitalization. During the index hospitalization, 81% were intubated, 39% had resuscitation, and 22% had hemodialysis. Two or more physician reviewers identified 34 (47%) of terminal oncology ICU hospitalizations as clinically avoidable. All three specialty physicians agreed about the avoidability 43% of the time. Conclusions: A review of terminal oncology ICU hospitalizations demonstrates that most of these patients had an advanced malignancy and poor clinical status and underwent aggressive EOL interventions. A significant number of these hospitalizations were identified as clinically avoidable by two or more physician reviewers. By identifying avoidable terminal oncology ICU hospitalizations, we can design interventions to prevent them.
Bringing person-centered care to practice with CCO’s guideline for person-centred care in adult oncology services.
Authors: Moody Lesley , Nicholls Brett , Shamji Hannah , Johnson Neil , Zwaal Caroline , Stevens Christian , Biddy Rhonel , Griffin Carly , Laroque Gail , Messersmith Hans , Singh Simron 
Published: February 2017

65 Background: CCO ensures quality cancer care for 16 million residents in Ontario. CCO has identified person-centered care (PCC) as a top strategy in driving the quality agenda. CCO, in collaboration with the Program in Evidence-Based Care, developed a PCC Guideline to set the standard of care for people experiencing cancer in Ontario. A PCC video was developed as a tool for translating this knowledge to support healthcare providers to integrate Guideline recommendations into their practice. Methods: A Guideline Working Group (GWG), including patients and health care providers, conducted a literature review and assessed the quality, relevance and utility of available evidence. An Expert Panel reviewed the decisions of the GWG and an External Review was conducted to validate the final guideline. The PCC video was developed as a tool for knowledge translation by defining fundamental concepts of PCC with the objective of promoting uptake of the guideline. A 4-question survey based on the Kirkpatrick Model was embedded to evaluate the video’s effectiveness. Results: Of 110 articles, only one guideline was found and was therefore reviewed exclusively. The GWG reviewed 68 recommendations, modifying 48, accepting 13 and rejecting 4; for a final set of 65 recommendations. External Review returned 73 responses. A total of 196 health care providers, 134 administrators, 53 patients and 103 others stakeholders participated in the video survey. The results in the table below compare the educational state of PCC before and after the video. Conclusions: CCO has adapted and endorsed 65 recommendations to create a PCC Guideline for adult oncology in Ontario. The results of the video showed that baseline PCC knowledge is poor, and that the PCC Video initiated significant (p = 0.972) growth in this knowledge. Anecdotal evidence also suggests that the video positively affected health care provider's confidence in adopting PCC. Future work is required to promote uptake and utilization of PCC Guideline at system-level. [Table: see text]
Integrated post-surgical colon cancer care planning at the Rutgers Cancer Institute of New Jersey and Robert Wood Johnson University Hospital.
Authors: Brown Teresa V. , Donohue Kristen , Patella Sondra , Dombrovskiy Viktor Y. , Moss Rebecca Anne , Maloney Patel Nell 
Published: February 2017

75 Background: Colorectal cancer is the second leading cause of cancer death in the United States each year. The use of adjuvant chemotherapy after surgical resection of colon cancer has been associated with a survival benefit. Timely initiation of adjuvant chemotherapy has been shown to have an effect on overall and disease-free survival. There is no integrated post-surgical colon cancer care planning for patients who have surgery at our institution. Poor understanding on the part of patients and ancillary providers regarding appropriate follow up may cause delay in time to adjuvant chemotherapy initiation. Methods: Baseline data was obtained for the ASCO Quality Training Program. Chart review was conducted on patients with stage III colorectal cancer that were treated at the Cancer Institute of New Jersey and Robert Wood Johnson University Hospital to identify average time to adjuvant chemotherapy initiation and factors which were thought to have a strong influence on chemotherapy initiation. Time to initiation of adjuvant chemotherapy, pathology report resulting, central access obtainment, and outpatient medical oncology appointment was abstracted from patient charts. Other factors including the presence of intraoperative or postoperative complications, type of surgeon, academic versus private medical oncologist, and the presence of an inpatient medical oncology consult were also identified and reviewed. Results: 128 patient charts were reviewed. Mean number of days from surgery to adjuvant chemotherapy (n = 79) was 49.6, to pathology report resulting (n = 70) was 4.92, to central access obtainment (n = 49) was 40, and to outpatient medical oncology appointment (n = 38) was 30. The presence of intraoperative (p < 0.059) and postoperative complications (p < 0.0155) was found to have a statistically significant effect on time to initiation of adjuvant chemotherapy. Conclusions: While there are some uncontrollable factors like operative complications that delay time to initiation of chemotherapy, engaging the patient may help decrease the time to adjuvant chemotherapy by increasing patient awareness of the importance of seeking aggressive postoperative care.
Using technology to improve patient-provider communication and delivery of quality care.
Authors: Rocque Gabrielle Betty , Hathaway Amanda , Halilova Karina I. , Gaguski Michele , Thomas Kathryn A , Stricker Carrie Tompkins , Hammelef Karen , Panzer SarahLena , Jacobsen Paul B. , Buzaglo Joanne S. , Blayney Douglas W. 
Published: February 2017

76 Background: Shared decision making (SDM) is a cornerstone of patient-centered care with 85-90% of breast cancer (BC) patients preferring an active or shared role in decision-making for breast surgery. SDM has been shown to, improve patients’ understanding of treatment options, result in more conservative care choices, and lead to lower healthcare costs. However, implementation is complex as numerous misconceptions exist. Methods: We are conducting a multi-site, quality improvement (QI) project to improve SDM behaviors and adherence to quality measures through a combination of provider education and use of a novel technology platform, the Carevive Care Planning System. This platform elicits patient preferences, concerns, history, and symptoms, and presents these data with algorithm-driven recommendations as part of a treatment plan. We report results from baseline provider surveys assessing perception and knowledge of SDM. Results: Baseline surveys from 28 participants were analyzed; 43% from a university based cancer center and 57% from community based cancer centers. Survey respondents were MDs (43%), NPs (7%) and RNs (46%), all specializing in Hematology and/or Oncology. When asked, “What percentage of breast cancer patients prefers an active or shared role in decision making?”, only 29% believed 85-90% of BC patients desired an active or shared role as suggested by surgical literature; 43% believed between 55-70% of patients wanted to be engaged in decision-making. Commonly reported barriers to SDM are shown in the table below. Conclusions: Physicians may underestimate patient’s desire to participate in shared decision-making. The barriers to implementing SDM in oncology practice will likely require multi-faceted interventions to overcome. We aim to address these gaps through an intervention aimed at enhancing knowledge and patient-provider engagement through treatment summaries. [Table: see text]