bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of race on early-stage lung cancer treatment and survival.
Authors: Williams Christina D. , Provenzale Dawn T. , Stechuchak Karen M. , Kelley Michael J. 
Published: February 2017

232 Background: Studies have documented racial differences along the lung cancer continuum and equity in care is essential to quality improvement. The purpose of this study was to investigate the influence of race on lung cancer treatment and survival among early-stage non-small cell lung cancer patients in an equal access healthcare system. We hypothesize that patients receiving similar treatment will have similar survival. Methods: Data were from the External Peer Review Program (EPRP) Lung Cancer Special Study, which was a cross-sectional study conducted to assess the quality of care among patients diagnosed with lung cancer and receiving care at a VA facility. All patients were diagnosed between October 1, 2006 and December 31, 2007. Analyses were restricted to patients with Stage I/II NSCLC (n=1,426; 1,229 whites, 197 blacks). Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). Results: The proportion of blacks who had surgery was significantly less than that among whites (OR: 0.56, 95% CI 0.39-0.79). There was no racial difference in receipt of adjuvant therapy (chemotherapy and/or radiation therapy) among patients who had surgery (p=0.08). Among patients who did not undergo surgery, blacks were more likely to refuse surgery (OR: 2.30, 95% CI 1.29-4.13); however, the proportion of patients with contraindications to surgery and those receiving palliative treatment were similar in both race groups. The 2-year survival rate was 69% and race was not a predictor of survival when controlling for receipt of surgery along with other covariates (p=0.76). The 2-year survival rate was 82% among patients who had surgery, and 48% among patients who did not have surgery. Specifically among patients who did not have surgery due to refusal, the survival rate was 55%. Conclusions: We observed a racial disparity in surgery, partially due to the greater rate of refusal among blacks, but not adjuvant or palliative treatment. Race did not have a major impact on 2-year survival for patients with early-stage lung cancer. These findings stress the need to better understand patient preferences regarding surgery and identify ways to reduce this variation in surgery to improve quality of lung cancer care.
Measuring patient satisfaction in oncology.
Authors: Steele Joseph Rodgers , Clarke Ryan Kristopher , Shoemaker Stowe 
Published: February 2017

236 Background: Improving the patient experience has been an increasingly important quality improvement goal for most health care institutions; however, all patients are not equal. Within the oncology community exist a host of unique needs that must be identified, measured, and addressed. Commercially available questionnaires are too general and often non-diagnostic. The goal of our study was to develop a method to better identify, quantify, and address the needs of this population. Methods: Over 60 hours of in-depth qualitative interviews were conducted with a diverse population of patients (n=68), physicians (n=28), nurses. and technologists (n=33) at UT MD Anderson Cancer Center. A customized patient-experience questionnaire was created from the qualitative data obtained. A balanced incomplete block design was used so each patient answered only 60 questions, while the questionnaire contained over 85 questions. The questionnaire was administered via email to approximately 30,000 patients over one week time period. Results: A total of 4,179 patients completed the survey with average completion time of 24 minutes. A total of 6,909 opened the email invitation, 6,007 began the survey (a 69% completed/began response rate). Non-response bias was monitored via a short survey completed by 2,094 patients. Analysis revealed little difference between respondents and non-respondents. The survey results showed the following: (1) when relevant, a patient will complete a lengthy survey (2) a patient’s perception of their experience is directly related to how they perceive themselves (a number, customer, patient, or loved family member) (3) higher satisfaction is correlated with perception of a “unique” interaction or service (e.g. a visit with a sub-specialty oncologist versus one with a parking attendant). Conclusions: Proper survey techniques are necessary to identify, measure, and address the needs of oncology patients. Contrary to popular belief, patients are willing to complete lengthy questionnaires with little survey fatigue. Positive patient experiences correlate with patient perceptions of provider empathy, caring, and treatment similar to that of a “loved family member” as well as unique, health care services.
Quantification of physician workload for radiotherapy planning, and possible associations with performance.
Authors: Mazur Lukasz M. , Mosaly Prithima , Jones Ellen , Hoyle Lesley , Chera Bhishamjit S. , Zagar Timothy , Marks Lawrence B. 
Published: February 2017

245 Background: Workload is a hypothetical construct representing the overall human cost incurred during a task. Across disciplines, the NASA Task Load Index (TLX) has been used as a subjective measure of workload. It quantifies six dimensions of work (mental, physical, and temporal demands, frustration, effort, and performance) on a scale of 1-100 scale, with scores >55 (i.e. overworked) associated with lesser performance. We herein quantify differences in physician workload for planning a relatively “simple” (palliative 2 field opposed lateral brain) versus relatively “complex” (curative 4 field pancreas) case. Further, we explore the association between workload and performance to define TLX levels where performance could be expected to decline. Methods: Nine physicians planned two cases, each case involving three tasks (i.e., task 1 - review written patient medical records; task 2 - review diagnostic images and design of treatment fields; and task 3 - review and approval of the treatment plan). After completing each case, TLX scores of each case/task was collected. Differences in workload between cases/tasks were assessed via ANOVA. The association between workload and performance (assessed using time-to-task completion and self-assessments) was assessed via Pearson’s correlation test. Results: 54 TLX workload and performance assessments were obtained. Workloads for the simple brain case/tasks averaged 41-48, versus 62-69 for the complex pancreas case/tasks (p<0.001 via ANOVA). There were no differences between tasks for the individual cases (p>0.1). There was a correlation between TLX scores and time-to-complete (r=0.54, p<0.001), and with physician self-assessments (r=-0.74, p<0.001). There was a trend towards reduced performance with TLX scores > 55. Conclusions: Physician workload levels are markedly lower for “simple” versus “complex” cases, indicating that TLX is a reliable tool to quantify workload. Performance appears to decline at TLX levels > 55, which is consistent with findings from other industries. Thus, we propose workload assessment (via TLX) to be considered as an independent quality measure to assess the quality assurance (QA) of processes used to deliver radiation therapy.
Thirty-day all-cause readmission rate at a cancer center as a quality of care measure.
Authors: Walters Ronald Stewart , Kidin Lisa M. , Roquemore Joyce , Jordan Victoria S. , Browning Douglas 
Published: February 2017

247 Background: Recently, a 30-day all-cause readmission rate has been proposed as a measure of quality of care. Readmissions are assumed to reflect failure by the discharging physician, hospital, or post acute care. These rates are generally easily calculated from available administrative data, and classifiable as "related to the previous discharge diagnosis" or not. Present on admission modifiers may enhance classification and assignment to "preventable" or "non-preventable," "expected or non-expected." This methodology is not generally applicable to the oncology population. The experience with one major cancer center is presented as an example of the limitations of such an approach. Methods: We analyzed 52,097 oncology admissions in an all-payer population that occurred between January 2010 and January 2012. Results: A mean of 32.5% (n=16,918) were readmitted within 30 days, compared to a "peer" group in the database of the University Health Consortium, median of 15%. The attached graph demonstrates the stability of this proportion. Leukemia, lymphoma, stem cell patients (46%), all patients with intense medical needs and frequent readmissions, n=7,635, were the largest subgroup. 42% (n=7,099) were readmissions for chemotherapy or immunotherapy, both planned and expected, and 11% (n=1,803) due to neutropenic fever, pneumonia, or sepsis, all common in this population and neither unexpected nor usually preventable. The most preventable, unexpected, and unplanned readmissions were for postoperative infection, dehydration, and urinary tract infection, accounting for 3.6% (n=609). Thus, the majority of readmissions were planned, expected, or not preventable. Conclusions: In a cancer population at an academic cancer hospital, the majority of readmission are not only planned, but also expected for this population of patients and should not be construed as representative of a quality of care issue. Proper stratification and classification of readmissions is essential to the interpretation of such a measure.
The psychosocial matrix: A community-derived evaluative tool for designing quality psychosocial cancer care.
Authors: Forsythe Laura Pence , Rowland Julia Howe , Padgett Lynne , Blaseg Karyl , Siegel Scott , Dingman Chad M , Gillis Theresa A. 
Published: February 2017

250 Background: Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, guidance regarding the essential components of comprehensive care or progressive steps for implementing each component is limited. This abstract presents a unique tool for self-assessing capacity to provide quality psychosocial care to cancer survivors and results of the first full-scale implementation of this tool. Methods: The psychosocial workgroup of the National Cancer Institute Community Cancer Centers Program (NCCCP) developed the Psychosocial Care Matrix Assessment Tool which covers 7 domains (e.g., distress screening, patient-provider communication, evaluation of psychosocial programs). All NCCCP sites (16 enrolled in 2007, 14 enrolled in 2010) completed the matrix in 2010 regarding their capacity for psychosocial care at entry into NCCCP (baseline), after two years of NCCCP participation (2007 sites only), and within the coming year (future aspirations). Results: At baseline, matrix responses reflected few or no systematic processes in place for most components of psychosocial care. However, reported capacity to deliver specific components improved at two years post-NCCCP entry for the 2007 sites and in all sites’ future aspirations. For example, about 80% of all sites reported no or inconsistent distress screening at baseline. After two years, 48% of the 2007 sites reported consistent screening with a standardized tool or consistent screening plus a comprehensive interview. Nearly all 2007 sites (89%) aspired to provide consistent screening plus comprehensive interview with 50% also hoping to add systematic follow-up screenings. The majority of 2010 sites (71%) aspired to provide consistent screening with a standardized tool. Conclusions: The psychosocial matrix tool was found to be useable and valuable. At the NCCCP sites, some aspects of psychosocial care (e.g., communicating the importance of psychosocial care) are more readily implemented than others (e.g., follow-up after a positive distress screen). With growing demand on cancer centers to meet new metrics of quality care, the psychosocial matrix can help identify and develop steps to address gap areas.
Development of quality indicators for women at high risk for breast cancer.
Authors: Shahrokni Armin , Chun Patrick Youngwhan , Naeim Arash , O’Leary Erin M. , Petruse Antonia , Keefer Lisa Jo , Wenger Neil 
Published: February 2017

264 Background: Thousands of women are at higher risk for developing breast cancer because of personal (such as early menarche, nulliparity), familial (e.g. BRCAI and II gene mutations), or clinical risk factors (e.g. chest wall radiation). It is thought that many, if not most, of these high risk women are not currently recognized and therefore not offered approaches to risk mitigation and early diagnosis; however, there is currently no set of measures to evaluate the quality of care provided to these women. We aimed to develop valid and feasible process-of-care quality indicators (QIs) for care of women at high risk for breast cancer. Methods: 2,402 articles from 2002 to April of 2012 were found to be appropriate for our study by search on PubMed and Medline. Studies were included if they showed a relationship between care processes for the identification, detection and risk reduction of breast cancer in women at high risk of the disease. Two reviewers reviewed the abstracts and then full texts of articles, and reviewed guidelines from the American Cancer Society, US Preventive Services Task Force and the National Comprehensive Cancer Network guidelines in producing a monograph of evidence supporting proposed QIs. A multidisciplinary panel of clinicians reviewed the evidence and rated each proposed QI for validity and feasibility. They then convened for a face to face meeting to discuss disagreements and then re-rate the measures. Results: Of 36 proposed QIs, 18 QIs were judged as valid and feasible to measure quality of care provided to women at high risk of breast cancer. Four QIs focused on identification of high risk women and risk communication. Six QIs related to counseling and genetic testing. Four QIs aimed at early detection and four QIs related to risk reducing interventions. No physician intervention to change a woman’s life style was rated highly enough to be a quality of care measure. Conclusions: A set of 18 QIs for the care of women high risk for breast cancer was developed along with the supporting literature and these measures will be applied to identify whether there are areas of care in need of improvement.
Aligning cancer quality metrics across the continuum of community-based and academic medicine using a prioritization tool.
Authors: Kidin Lisa M. , Stary Susan , Schaub Diane , Walters Ronald Stewart , Jordan Victoria S. , Edwards David , Cianfrocca Mary E. , Simeone William , Browning Doug 
Published: February 2017

270 Background: The Accountable Care Act (ACA) created a foundation for value based purchasing to increase quality of care. This resulted in a request for metrics from multiple organizations at both national and state levels interested in improving healthcare delivery through measurement. Competing with these are internal disease specific metrics requested by organizational leaders to judge the quality of services in their area. In 2009, Banner Health created a partnership with MD Anderson to form Banner MD Anderson Cancer Center. This partnership includes ensuring care provided across both organizations is comparable, and meets evidence based guidelines, including the challenges of developing and tracking clinical metrics that represented quality and value for both a community hospital and an academic medical center. Methods: Banner and MD Anderson compiled a list of all relevant external and internal metrics currently collected plus those in development to create a unified approach for collecting and comparison of cancer specific, hospital, physician, and department specific measures. However, both institutions faced the challenge of resource constraints, competing priorities and appropriate informatics infrastructure. To address this issue, an objective metrics prioritization tool was created based on Failure Mode and Effect Analysis and Quality Function Deployment methods used in quality improvement. The tool provides the flexibility of adjustable weights in the components of Quality, Data, and Organizational Utility for each organization. Results: Prior to the tool, both sites had no basis for comparison or strategic alignment as to which measures to report. The tool was independently scored by institution, resulting in 90% alignment. The remaining difference was attributed to variation in informatics systems and resource allocation. Conclusions: Data while limited, demonstrates that the tool provides an objective measure of comparison between two organizations. While it continues to evolve and require further testing, it does provide an opportunity to facilitate harmonization between measures and alignment of various stakeholders both internally and externally.
MD Anderson Cancer Center Ongoing Professional Practice Evaluation (OPPE): We can see clearly now.
Authors: Roquemore Joyce , Kian Leslie 
Published: February 2017

277 Background: Reviewing clinical practice by provider has been an ongoing process for quite some time. The metrics reviewed and how the review was conducted were not clearly defined and, as a result, has varied widely between organizations. Recredentialing or some self-imposed process were the main drivers until The Joint Commission required a more regular review of the clinicians’ practice in a hospital and clinics setting. MD Anderson embraced the requirement as an opportunity to improve its clinical review process and create a more robust infrastructure. Methods: Organizational and technological support was critical for success. The OPPE effort is led by the V.P. for Medical Affairs. A new faculty role, Quality Officer (QO), was established in each clinical department. The Office of Performance Improvement (OPI) was enlisted for data support and provided educational resources to the QOs. The Information Services staff maintains the technology to support the project long term. The Medical Staff Office has administrative responsibility for the program. Results: Two bi-annual OPPE reviews for credentialed providers (physicians and mid-levels) have been completed under the new process. Electronic display and processing has eliminated volumes of paper needed to track OPPE for 1,000+ faculty. External audit requirements are easily supported. Early adopters of the new OPPE tools have been complimentary of the support provided by display of values in control chart versus table formats. The application of statistical process control rules help QOs understand variation in performance among faculty and aid in identifying statistically valid quality issues. Conclusions: MD Anderson leveraged the OPPE requirements to make organizational changes and create processes that enhance review of clinical practice with electronic tools that improve decision making and analytical capabilities. The implementation of clinical quality metrics has made it clearer to see how each practice is doing based on criteria they defined, as well as create a path towards developing oncology performance metrics that can be considered nationally.
Public reporting outcomes of multidisciplinary cancer care: Conceptual issues.
Authors: Talcott James Austin 
Published: February 2017

280 Background: Patient outcomes are the most valid measures of quality of care. Public reporting makes them available to patients, referring physicians and payers. Our institution has committed to reporting all cancer patient outcomes. In carrying out that objective, we encountered novel analytical issues arising from differences between the usually reported treatments, surgical procedures, and multidisciplinary cancer care. We present important conceptual issues we identified. Methods: Analytic description of methodological issues encountered in publishing cancer patient outcomes. Results: Issues include: (1) Assigning responsibility. Patient outcomes of multidisciplinary cancer care can be influenced by multiple oncology specialties and institutions. While providers directly control only the treatment they provide, providers share collective responsibility for executing the treatment plan, coordinating care and vouching for the quality of collaborating providers. Therefore, reporting outcomes of one element of multidisciplinary care is incomplete and inadequate. (2) Claiming responsibility. Providers with institutional affiliations but no involvement in quality improvement or reporting processes should be excluded from public reporting. Minimum requirements to qualify for public institutional affiliation should be enforced and “free riders” identified. (3) Defining and presenting valid comparison populations. Treatment trials’ eligibility criteria and recruitment practices exclude poorer prognosis patients, producing biased comparisons to complete “registry” populations that distort patient expectations. Publishing outcomes of well-characterized subpopulations improves valid results and provides more individualized information. Conclusions: Reporting patient outcomes after multidisciplinary cancer care raises novel conceptual issues. We discuss our response to three important issues.
Single-institution evaluation of intrafraction motion during frameless stereotactic radiosurgery.
Authors: Kowalchik Kristin , Kim Siyong , Serago Christopher , Smith Ashley , Ko Stephen 
Published: February 2017

284 Background: Frameless stereotactic radiosurgery (SRS) is single fraction radiation therapy delivered to an intracranial lesion. Rather than with a rigid head frame, frameless SRS uses a thermoplastic mask for immobilization. The benefit of this mask includes the ability to simulate and treat the patient at different times, ease of patient set-up and improved patient comfort. Clinically, frameless SRS is used for primary brain tumors and metastatic lesions. The length of the treatments may vary based on a number of factors, including total treatment dose, number of monitor units, number and arrangement of beams, and equipment manipulations. This is a single institution review of patients treated with SRS with positional checks made before, during and at the completion of treatment to evaluate intrafraction motion. Methods: Patients were treated with SRS at Mayo Clinic Florida between 2010 and 2011. All patients were immobilized with a thermoplastic mask and treated on a Varian IX Clinac. KV Cone beam CT was taken prior to the initiation of treatment to verify the treatment position. Cone beam CT’s were also performed at the midpoint and conclusion of treatment. The same physician analyzed all cone beam CT’s. Adjustments were recorded in each dimension and analyzed to determine intrafraction motion. Results: Intrafraction motion was evaluated during six separate SRS cases. The mean displacements at mid-treatment were 0.67±0.52 mm, 0.50±0.55 mm, 0.83±0.75 mm, and 1.35±0.78 mm in the medial/lateral, superior/inferior, anterior/posterior, and vectoral direction, respectively. The mean post-treatment displacements were 0.17±0.41 mm, 0.67±0.82 mm, 0.50±0.84 mm, and 1.11±0.96 mm in the medial/lateral, superior/inferior, anterior/posterior, and vectoral direction, respectively. Estimated overall margins to accommodate intrafraction motion in 90% of patients were 2.63 mm and 2.69 mm at mid-treatment and post-treatment, respectively. Conclusions: The majority of intrafraction motion occurred during the first portion of treatment. Intrafraction motion during the course of frameless SRS treatment is not negligible and approximately a 2.5 mm margin should be taken into account during the planning process.