bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of QOPI at Illinois CancerCare, P.C. (ILCC).
Authors: Howard Kendall , Heard Bridgette , Kumar Pankaj , Miller Laura M. 
Published: February 2017

174 Background: ASCO’s Quality Oncology Practice Initiative (QOPI) is a practice based quality improvement program based on retrospective chart reviews. Data collection is performed twice a year. If scores meet a specified level, a practice may apply for certification. In order to achieve certification, a physician practice must meet minimum threshold scores in five areas including: Core, Symptom/Toxicity, Care at End of Life, Breast Cancer, Colon/Rectal Cancer and Non-Small Cell Lung Cancer. A QOPI on-site review is conducted after application. Once the application has been approved, the on-site review includes an audit of chemotherapy preparation and administration, patient education, treatment planning and the review of applicable policies. If acceptable, a 3 year certification is awarded to the practice. Methods: ILCC began QOPI participation in Fall 2011. For the first round, the scores were lower than the required minimum threshold certification score level requirements. The certification areas with lower than desirable scores included: Pain Score Assessed, Emotional Well Being Assessed and Colonoscopy within specified time frame. To improve scores, a committee was formed to identify improvements. Improvements included revising physician templates to include new areas and language. Physicians were also given the appropriate verbiage for assessing a patient’s Emotional Well Being, and employees also were engaged in our improvement efforts by addressing areas that needed to be asked in the first and second visits only. Results: All selected measures show improvement from Fall of 2011 to Spring of 2013. Pain addressed appropriately increased 59% (26% to 80%); patient emotional well being assessed increased 32% (19% to 51%), colonoscopy before or within 6 months of curative colorectal resection improved 35% (50%-86%). Our total certification score went from 72.05% to 87.99%, a 15% improvement. We applied for certification and became a QOPI certified practice in fall of 2012. Conclusions: QOPI is an effective program for evidence based quality improvement within oncology practices.
Unit redesign to improve safety, quality, and patient and nurse satisfaction.
Authors: Woodrum Theresa , Kneifl Missy , Aning Christina 
Published: February 2017

179 Background: Increased emphases have been placed on hospital safety, and patient and nurse satisfaction in the competitive cancer care arena. The current climate demands critical attention to stakeholder input in cancer care delivery. Methods: Stakeholder (patients, families, nurses, physicians, and other members of the multidisciplinary care team) input directed efforts in an adult/pediatric oncology/hematology unit renovation. A true focus on stakeholder involvement was evident by uniting the patient advisory council from the cancer care service line, multidisciplinary staff, and unit-based shared governance structures to form the design team. Uniting multiple perspectives and eliciting design team ideas and recommendations ensured renovation plans remained focused on improved care delivery and processes. The design team discussed all aspects of renovation, including work flow, equipment/technology needs, safety and security, and family/child friendly spaces. A key feature of the renovation was the universal room concept, which meant that rooms needed to be adaptable to a cancer patient’s changing needs: from standard care to critical care. Stakeholder input was sought on as all aspects progressed as final decisions were made on aesthetics, family-focused amenities, work flow structures such as location of equipment and supplies, and patient safety features (especially in bathroom spaces). Results: Total falls decreased from 6.17 to 3.1 per 1,000/pt days and falls with injury decreased from 2.9 to 1.8 per 1,000/pt days. Improvements in patient satisfaction scores were seen in “overall room” scores increasing from 79.9 to 90.5 and “visitor /family” satisfaction increased from 87.9 to 92.1. Overall nursing satisfaction improved from 56.68 to 64.58 and job plans to remain on unit rose from 63-89. Conclusions: Avoiding a top-down, hierarchical decision-making process from conceptualization to realization resulted in measurable changes in patient safety and patient and staff satisfaction from pre- to post-renovation. This process can utilized to address the changing needs in cancer care.
Cancer center improvement through practice-based clinical leadership team infrastructure.
Authors: Coniglio Mary , Cunningham Regina , Gillespie Dawna 
Published: February 2017

180 Background: A practice based clinical leadership team (PBCL) was created in the outpatient cancer center to identify, evaluate, and implement initiatives to improve safety, quality, and patient satisfaction. A quality leader facilitates the team which includes nursing, physician leaders, as well as subject matter experts from throughout the cancer service line. Methods: Key focus areas include data review/analysis, facilitating performance improvement teams to enhance patient satisfaction and patient safety; and to reduce variations in care. PBCL members participate in Performance Improvement in Action (PIIA) program that includes just-in-time process improvement training while completing projects in a 90-day period. The PIIA approach embeds quality/lean tools in the organization. The training provides structure, common terminology, and stresses the use of data to make decisions, relying on the voice of the customer and clear articulation of the problem statement before jumping to solutions. The methodology incorporates six sigma/lean tools and plan-do-check-act. Results: The PBCL structure has resulted in several specific improvement projects. The patient throughput project team implemented recommendations that increased the percentage of patients who arrived and completed lab tests before their scheduled appointment time by 36%. In addition, a simulation model was created which quantified a 28 minute reduction in total time in the department by increasing the number of patients seen independently by advanced practice providers and removing the room assignment constraint by assigning providers to a “pod of rooms” rather than a specified room(s). An infusion fast track program was implemented for selected medications to expedite patient throughput resulted in an 18 minute (52%) reduction of time in the department. Conclusions: Incorporating clinical leadership in a structured framework for quality improvement increases the buy-in to change while maintaining an objective, data driven approach. The team approach and use of performance metrics provides the opportunity to expedite pilot project testing while raising awareness of key metrics to inform of additional opportunities.
Breast cancer risk assessment: How risk models can “overdiagnose” risk.
Authors: Ozanne Elissa , Drohan Brian , Hughes Kevin S. 
Published: February 2017

184 Background: Overdiagnosis is commonly defined as a diagnosis of "disease" which will never cause symptoms or death during a patient's lifetime. Similarly, overdiagnosis can also happen when individuals are given the diagnosis of being at risk for a disease, such as being at high-risk for developing breast cancer. Women can be given such a diagnosis by meeting a set of risk assessment criteria, which are often accompanied by recommended management strategies. We sought to identify the extent and consequences of overdiagnosis for individuals being at high risk for breast cancer using the American Cancer Society (ACS) guidelines for the appropriate use of Magnetic Resonance Imaging (MRI). Methods: We identified women who fit the ACS criteria in a population based sample at a community hospital. The ACS criteria mentions three risk assessment models for determining a woman’s risk, and these criteria were reviewed to determine the extent of possible overdiagnosis in this population. The expected resource utilization resulting from this overdiagnosis, and the impact on patient quality of life are extrapolated. Results: 5,894 women who received mammography screening at the study site were included. 342 (5.8%) of the women were diagnosed as high risk by at least one model. However, only 0.2% of the total study population were diagnosed as high risk by all three models. One model identified 330 (5.6%) to be at high risk, while the other two models identified many fewer eligible women (25, 0.4% and 54, 0.9% respectively). Conclusions: Using different models to evaluation the ACS criteria identifies very different populations, implying a large potential for overdiagnosis. Further, this overdiagnosis is likely to result in the outcome of screening too many women, incurring false positives and unnecessary resource utilization.
Decision regret following treatment for localized breast cancer: Is regret stable over time?
Authors: Martinez Kathryn Anne , Resnicow Ken , Hawley Sarah T. 
Published: February 2017

19 Background: While studies suggest most women have little regret with their breast cancer treatment decisions, few (or no) studies have evaluated whether regret changes over time. Methods: Women diagnosed with breast cancer between August 2005 and May 2007 reported to the Detroit, Michigan, or Los Angeles County Surveillance Epidemiology and End Results (SEER) registry completed surveys at 9 months post diagnosis (time 1) and again approximately 4 years later (time 2). A decision regret scale (Brehaut, 2003) consisting of 5 items was completed at both time points. Item responses were summed to create a regret score at both 9 months and 4 years (scales of 5 to 25 points, with 25 being most regret). We used multivariable linear regression to examine change in regret from 9 months to 4 years. Independent variables included surgery type (breast conserving surgery, unilateral mastectomy, bilateral mastectomy), presence of invasive disease (yes/no), and recurrence status (yes/no) at follow-up. We included an interaction between surgery type and recurrence status. The model controlled for demographic and clinical factors. Results: The sample included 1,497 women. Mean decision regret at 9 months was 9.5 points and 10.1 points at 4 years (range 5-25) (NS). Two-thirds (64%) of respondents had breast conserving surgery, 26% had unilateral mastectomy, and 9% had bilateral mastectomy. We found no impact of surgery type on change in regret in the overall sample. However, among the, 86 (6%) women who recurred, those who underwent unilateral mastectomy reported significant reduction in decision regret over time relative to recurrent women who had breast conserving surgery (d= -6.76, p=0.024). Average change in regret among non-recurrent women was 0.52 points and was 2.7 points for women who recurred. Conclusions: Decision regret in breast cancer is generally stable over time, yet changes in regret appear to be associated with disease trajectory and treatment received. Our results suggest that more extensive treatment is associated with a reduction in regret only when women experience a recurrence. Understanding patients’ assessment of their decisions related to treatment may be useful for informing future decision making processes.
An interdisciplinary model for predicting patients at high risk for readmission amongst solid tumor oncology patients in a comprehensive cancer center.
Authors: Shinde Arvind , Nolen Ruth , Hein Marjorie Jen , Siccion Eduardo , Crocitto Laura E. , Kassab Tricia , Morse Denise , Leong Lucille A. 
Published: February 2017

190 Background: Increasing emphasis is being placed on reducing hospital readmission (readm) rates. Reduction of hospital readm remains a challenge, especially among the oncology population. Identifying patients (pts) at increased risk can assist with developing targeted interventions. Methods: From 1/1/11 to 12/31/12, an interdisciplinary team consisting of medical oncologists, hospitalist physician and NP, QI specialist, and case manager prospectively reviewed the medical oncology inpatient census on a biweekly basis to identify pts at risk for readm. Pts with any of the following conditions were considered at high risk for readm: significant pain, wounds, intestinal obstruction, refractory neutropenia despite GCSF, elderly/frail, unstable housing, patient/family non-compliance, rapid cancer progression, refusal of appropriate hospice care, and stalled care plans. These criteria were based upon previous years’ anecdotal experience. Interdisciplinary interventions to address these conditions were identified and initiated. Results: 272 pts were assessed during these sessions. Each session took on average 60 minutes. 69 pts (25%) were deemed to have at least one high risk factor. Chart review revealed that 6 died in the hospital and 13 were discharged to hospice. No pts on hospice were readmitted. Of the remaining 50 high risk pts, 14 (28%) and 25 (50%) pts were readmitted within 14 days and 30 days, respectively. Conclusions: This interdisciplinary team model seems to have a fair predictive value in identifying pts at higher risk for readmission. However, it is time and labor intensive. Enrollment of appropriate high risk pts in hospice mitigates this risk. Given the current emphasis on decreasing readm and the increased cost/penalties associated with readm, the next step will be to pilot cost-effective interventions for pts with these high risk factors. Potential interventions which we have instituted include follow-up calls, social service referrals, intensive family/pt education, clinic appointments within 3 days of discharge, greater coordination with primary care physicians, and more effective hospice discussions. Supported by CA 62505.
Evaluation of oral chemotherapy prescribing at an outpatient oncology clinic.
Authors: Carro George W. , Brockstein Bruce , Hensing Thomas A. , Fleming Patrick Joseph , Gavin Shannon Maureen , Spath Wayne , Harper Abigail , Hui Wendy , Uhlig William J. , Hughes Brad 
Published: February 2017

191 Background: Oral chemotherapy’s exponentially increasing role in the treatment of malignancies continues to pose unique challenges to oncology. The American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) drafted measures in the Chemotherapy Administration Safety Standards that help address some of these issues concerning oral chemotherapy. There is a lack of data describing the prescribing process for oral chemotherapy. In a retrospective chart review, prescriptions at a hospital-based outpatient oncology center were evaluated for completeness of prescribing and follow up measures. Methods: A retrospective chart review of ten oral chemotherapy medications from May 2012 to July 2012 was conducted. The primary outcome measure was compliance with ASCO and ONS Chemotherapy Administration Safety Standards. A secondary outcome was frequency of pharmacist interventions on oral chemotherapy prescriptions. Results: 412 prescriptions were evaluated. Prescriptions were graded on a scale from 1 to 8. One point was given for inclusion of each of the following: prescribing physician, patient name, drug name, dose, dosing methodology, quantity, refills, and accurate directions. Of all the prescriptions, 23% contained all aspects of a complete prescription. The most common reasons for point deductions were contradictory or unclear directions and allowing refills for oral chemotherapy which should not be refillable. Four percent of prescriptions had a documented pharmacist intervention. Conclusions: This study revealed areas for improvement in the prescribing process of oral chemotherapy. Targeting directions and refill fields within prescription templates will improve compliance with ASCO and ONS standards. This can be accomplished by implementing customized oral chemotherapy prescription templates within treatment plans in the electronic medical record system. Unlike chemotherapy administered in the clinic setting, oral chemotherapy prescriptions are not generally reviewed by oncology trained pharmacists. With the collaboration of medical and nursing staff, a new work flow was implemented which includes pharmacist review of electronic oral chemotherapy prescriptions.
Expectations of discipline representation on multidisciplinary treatment planning (MTP) teams.
Authors: Prabhu Das Irene , Mallin Katherine , Gay E. Greer , Rozjabek Heather , Fennell Mary L. , Stewart Andrew K. , Castro Kathleen M. , Clauser Steven 
Published: February 2017

195 Background: The Commission on Cancer’s (CoC) standards require accredited cancer programs to utilize a multidisciplinary team approach for treatment planning. A recent CoC survey sought to characterize current multidisciplinary treatment planning (MTP) practice from the cancer programs’ perspective. Methods: The survey, administered to 1,261 programs, included items on team structure and process, case presentation, clinical trials and patient involvement. Each facility was designated to report on MTP for one cancer type: Breast, Gastrointestinal (GI), Lung, Head/Neck, Gynecologic (Gyn), Brain/Central Nervous System (CNS). A total of 797 (63%) facilities responded. Initial analyses highlight the disciplines expected to attend MTP meetings. Results: Forty-eight percent expected all core physician specialties (Medical Oncology, Radiation Oncology, Surgery and/or Surgical Oncology), to attend the initial case presentation. Respondents also expected affiliated specialists and professionals to attend initial case presentations, and included pathologists (90%), clinical trials nurses (46%), patient navigators (37%), primary care providers (20%), and genetic counselors (18%). Data analysis demonstrated significant variation in expected disciplinary attendance for select providers depending on type of cancer program, as illustrated below (Table). Analysis by cancer type showed that primary care physicians were expected to attend Lung MTP meetings at 25% of the facilities compared to Breast (15%). Genetic counselors were expected to attend MTP meetings for Breast (29%), Gyn (24%), and GI (18%). Additional analyses are ongoing. Conclusions: To improve cancer care quality, the CoC has put forward standards to foster multidisciplinary professional participation in the treatment of cancer care. Findings indicate expectations of attendance for key disciplines at MTP meetings vary by tumor–specific MTP and by type of cancer program. Key genetic markers for certain sites may also explain why genetic counselors are expected to attend. [Table: see text]
Improving utilization of patient portals through a multifaceted intervention strategy.
Authors: Higgins Patrick , Gillespie Dawna , Coniglio Mary , Guerra Carmen 
Published: February 2017

205 Background: Healthcare’s paradigm shift is in full swing. Electronic medical record (EMR) systems are up and running across the country, creating the potential for a more interactive environment for patients. With Stage 2 of the Affordable Care Act’s Meaningful Use requirements approaching in 2014, health systems are being challenged to determine how to effectively engage with patients electronically. MyPennMedicine is the portal used at the Abramson Cancer Center, and its use has been incredibly low since its introduction in 2009. Methods: Our assessment focused on patient portal account activations, messaging volume, and follow-through. Baseline measurements of these variables were abysmal. We convened an inter-disciplinary team of stakeholders (including patients, physicians, nurses, IT, front desk, and marketing) to understand current barriers to portal use, and to develop innovative methods aimed at improving use of the tool. Our team cultivated a strategy that included system upgrades based on end-user feedback, provider education about the benefits of the portal, patient demonstrations, and improving the ease of patient sign-ups. Results: At baseline (February, 2013), we determined that only 13% (18/139) of patients who had been assigned a code to access the patient portal actually did so. Our response to patient requests via the portal was only 58% (216/374). Moreover, the average time it took providers and staff to complete patient requests was 17.1 hours. After our first round of interventions (May, 2013), the rate of account activation increased to 45% (110/244) and our response to patient requests increased to 73% (331/455). The average time to complete the requests actually increased to 21.3 hours perhaps as a result of the increased volume. Conclusions: EMRs will continue to change the way we engage with patients. The clinical significance of our increase in patient portal usage is yet to be fully appreciated. Our initial interventions have resulted in significant increases patient awareness and utilization as well as improved follow-through by clinicians and staff. Future directions include additional interventions focused on technological improvements and continued education and clinician support.
Stakeholder-informed “Choosing Wisely” implementation project in regional oncology clinics.
Authors: Kreizenbeck Karma L. , Stewart F. Marc , Lehman Constance , Carlos Timothy , Chen Eric Y. , Jensen Barbara , Rieke John W. , Greer Benjamin E. , Bredeson Chris , Putnam Kristie , Ramsey Scott David 
Published: February 2017

207 Background: ASCO launched the Choosing Wisely campaign to reduce the use of interventions that lack evidence for their use in clinical cancer care. The recommendations have strong support, but lack an implementation plan. The objective of this project is to develop a stakeholder-informed process to improve adherence to ASCO Choosing Wisely within an experimental context. Methods: Participants include Medical Directors from 7 oncology clinics and 1 commercial insurer within the Puget Sound region, and the SEER Puget Sound Cancer Registry. The project consists of 3 phases (1) prioritization, (2) design, (3) implementation and monitoring. For phase 1, Medical Directors were surveyed via e-mail to prioritize the recommendations with the following criteria: importance for improving the value of cancer care; impact of adherence; urgency; and feasibility of implementing an intervention. Participants met via teleconference to discuss survey results, review regional utilization data, and design of interventions. Participants were surveyed again for a final ranking. In phase 2, participants discussed options for interventions and study designs. Results: Initially, the highest ranked recommendations were advanced imaging in staging of local stage prostate cancer, surveillance of local and regional stage breast cancer, and colony stimulating factor (CSF) use for low risk chemotherapy. After discussion, breast cancer surveillance and CSF prescribing ranked the highest. Participants requested utilization and cost-impact data from the health insurer for the top 2 choices. Conclusions: Using a transparent, multi-stakeholder process, it is feasible to implement programs to improve adherence to ASCO Choosing Wisely.