bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lung cancer screening knowledge and beliefs among primary care providers and pulmonologists.
Authors: Marsh Katie , Greenwood-Hickman Mikael Anne , Jones Laura , Rivera M. Patricia , Bowling J. Michael , Molina Paul , Maygarden Susan , Birchard Katherine , Reuland Dan , Henderson Louise 
Published: February 2017

191 Background: In response to the National Lung Screening Trial’s findings, numerous professional organizations have published guidelines recommending annual lung cancer (LC) screening with low dose computed tomography (LDCT) for eligible patients. In the wake of these guidelines, we sought to assess LC screening practices and beliefs among providers at a large academic medical center. Methods: In 2015, we surveyed 54 physicians and 9 residents in pulmonology (27% response rate) and 86 physicians and 100 residents in family/internal medicine (39% response rate). The 23 question Qualtrics survey focused on beliefs and knowledge about LC screening recommendations, guidelines, and practices. Results: Survey respondents in both groups were mostly White non-Hispanic clinicians with a mean age of 40 (range 28-67). Pulmonology respondents were mostly male (69%) and family/internal medicine respondents were mostly female (53%). The pulmonology group was more likely than family/internal medicine to believe that LC screening is beneficial for patients (p < 0.0001) and cost effective (p = 0.02). Over 76% of the pulmonology group reported ordering a LDCT for an asymptomatic patient in the past 12 months compared to 41% in the family/internal medicine group (p = 0.012). Additionally, 76% in pulmonology were aware of the American College of Chest Physicians recommendations versus 38% in family/internal medicine (p = 0.02). The majority of both groups agreed that an electronic prompt would increase the likelihood of referring a patient for LC screening. While both groups agreed that a LC screening registry would benefit the quality of patient care (100% pulmonology; 65% family/internal medicine; p = 0.02) and make them more likely to refer patients to a LC screening program (88%; 54%; p = 0.04), a significantly larger majority of the pulmonology group held these beliefs. Conclusions: Pulmonology respondents had more knowledge of guidelines and more favorable opinions of LC screening than family/internal medicine respondents. Our findings suggest future studies should focus on educating providers about recommendations and understanding why the family/internal medicine group is less likely to refer patients for LC screening.
Standardizing architecture and governance of radiology clinical checklist development.
Authors: Bedford Colleen , Jain Priyanka , Langer Deanna , Kwan David , Dobranowski Julian 
Published: February 2017

193 Background: To improve quality of radiology reporting, Cancer Care Ontario’s (CCO) Cancer Imaging Program established synoptic radiology reporting as a priority area. Program goals are to implement standardized radiology reports across the province, improving communication between referring and interpreting physicians and providing a standardized foundation for staging data collection and population health research. Although there are libraries of structured radiology clinical checklists, development methodologies quality vary. To support ongoing development and provide a framework to assess existing checklists, the program developed and published two white papers. Methods: To ensure checklists are consistent in format, the first white paper provides guidance on ‘architecture’ (high-level elements) of a cancer imaging report. To ensure the content of adopted checklists are based on high-quality evidence, the second white paper focuses on clinical checklist development governance. Both white papers were developed in consultation with multidisciplinary expert panels assembled by CCO and underwent peer review prior to being made available. Results: The architecture white paper outlines the minimum mandatory elements for cancer imaging reports. The elements to be included in these reports are: demographics, relevant clinical information, body of the report, and impression. This paper provides specific guidance for expert panels in the development of new clinical checklists as well as criteria for reviewing existing checklists. The governance white paper provides a clear methodology for a systematic approach to clinical checklist development for synoptic radiology. Included are recommendations on the constitution of the clinical expert panels, the level of evidence needed to support checklist items, external review of the checklist, and periodic checklist maintenance. Conclusions: CCO has developed two white papers that serve as a guide for both CCO and external parties in the creation of high-quality clinical checklists. Improved standardization of the structure and development approach for clinical checklists facilitates both in-house development and adoption of third party checklists.
Measuring adherence to a Choosing Wisely recommendation in a regional oncology clinic.
Authors: Egan Kathryn S. , Lyman Gary H. , Kreizenbeck Karma L. , Fedorenko Catherine R. , Alfiler April , Noble Heather , Kusnir-Wong Tracy , Mohedano Ada , Stewart F. Marc , Greer Benjamin E. , Ramsey Scott David 
Published: February 2017

196 Background: Natural language processing (NLP) has the potential to significantly ease the burden of manual abstraction of unstructured electronic text when measuring adherence to national guidelines. We incorporated NLP into standard data processing techniques such as manual abstraction and database queries in order to more efficiently evaluate a regional oncology clinic’s adherence to ASCO’s Choosing Wisely colony stimulating factor (CSF) recommendation using clinical, billing, and cancer registry data. Methods: Database queries on the clinic’s cancer registry yielded the study population of patients with stage II-IV breast, non-small cell lung (NSCL), and colorectal cancer. We manually abstracted chemotherapy regimens from paper prescription records. CSF orders were collected through queries on the clinic’s facility billing data, when available; otherwise through a custom NLP program and manual abstraction of the electronic medical record. The NLP program was designed to identify clinical note text containing CSF information, which was then manually abstracted. Results: Out of 31,725 clinical notes for the eligible population, the NLP program identified 1,487 clinical notes with CSF-related language, effectively reducing the number of notes requiring abstraction by up to 95%. Between 1/1/2012-12/31/2014, adherence to the ASCO CW CSF recommendation at the regional oncology clinic was 89% for a population of 322 patients. Conclusions: NLP significantly reduced the burden of manual abstraction by singling out relevant clinical text for abstractors. Abstraction is often necessary due to the complexity of data collection tasks or the use of paper records. However, NLP is a valuable addition to the suite of data processing techniques traditionally used to measure adherence to national guidelines.
Development of a radiation oncology-specific prospective data registry for clinical research and quality improvement: A clinical workflow-based solution.
Authors: Chen Allen M. , Wang Pin-Chieh , Verittupong Darlene , Shao Weber , McCloskey Susan Ann , Basehart Vincent , Steinberg Michael L. , Kupelian Patrick 
Published: February 2017

197 Background: The computerized ‘paperless’ medical recording system has transformed the modern health information system and serves as an idea platform for cancer registry development, particularly in a specialty like radiation oncology, where technological advances generate unprecedented amounts of data. Methods: From May 2011 to May 2015, physicians prospectively inputted data on patients seen during consultation in the Department of Radiation Oncology at UCLA. Using a customized interface established between an in-house registry and a commercially-available, hospital-based electronic medical record system (Epic Systems, Inc. Verona, WI), a parcel was created for data deposition, which was also linked to the Aria Treatment Planning Station (Varian Medical Systems, Inc., Palo Alto, CA). This registry was designed to assimilate into routine physician work-flow and was based on the completion of tabular entries, which were templated by disease sites. The total number of data fields per disease site ranged from 9 to 73 (median, 21). Results: A total of 7,646 patients were logged into the registry. Primary disease sites were prostate (N = 1,247), breast (N = 1157), head/neck (N = 726), central nervous system (N = 638), lung (N = 439), brain metastasis (N = 349), gastrointestinal (N = 238), gynecologic (N = 234), other (N = 2,618). The mean data capture completion rate by physicians was 55% (range, 32 to 65%); however, this rate did not differentiate between true incomplete (data available but not collected), versus data that was either unavailable, not required, or not applicable. A total of 46 independent, investigator-initiated research studies have been undertaken using queries supported by the registry from multiple access points, 8 of which were published in peer-reviewed journals. Conclusions: The development of a radiation oncology-specific registry not only enhanced research efficiency and facilitated quality assurance, but also fostered data reuse and promoted self-education by producing quality information to guide clinical practice. Our next steps include the integration of patient-reported outcomes through radiation oncology-specific surverys, the documentation of cost of delivery of care of specific treatment pathways, and the implementation of data collection processes in the community.
Understanding efficiency of chemotherapy delivery for planned chemotherapy admission at Columbia University Medical Center.
Authors: Accordino Melissa Kate , Wright Jason Dennis , Vasan Sowmya , Neugut Alfred I. , Hu Jim , Hershman Dawn L. 
Published: February 2017

206 Background: Delays in administration of planned in-patient chemotherapy can lead to prolonged length of stay (LOS), resulting in increased cost and risk of nosocomial infections and other complications. Methods: We conducted a retrospective analysis of cancer patients admitted to Columbia University Medical Center, a tertiary care center, for planned chemotherapy from January 1, 2014 through December 31, 2014. Eligible patients were identified as cancer patients (via ICD9 codes) who were admitted directly to the inpatient hematology/oncology service with intravenous chemotherapy orders submitted within 24 hours of the admission. Patients were excluded if they received oral, non-formulary, intrathecal, or high dose methotrexate therapy. For each admission, the duration of time from admission to infusion start time was recorded. We evaluated patients who were admitted to the Intensive care unit (ICU) separately. Chart review and provider interviews were conducted on a subset of patients. Results: Over 12 months, 314 unique hospital admissions involving 162 patients were included in the analysis. The median time from admission to chemotherapy infusion start was 15.8 hours (mean 31.5, IQR 3.1-41.0 hours). Of the 314 unique admissions, 299 (95.2%) did not require ICU involvement during their hospitalization. Of these patients, median admission to chemotherapy infusion start time was 15.5 hours (mean 29.9, IQR 2.9-38.9 hours). Chart review and provider interview were conducted for 22 patient admissions. In this subset, median time from admission to chemotherapy start was 13.6 hours. Top reasons for delays were: order modifications for lab abnormalities, lack of chemotherapy consent, and delay in chemotherapy delivery to inpatient units. Conclusions: In cancer patients admitted for planned chemotherapy we found a significant delay between hospital admission and infusion start time. Inefficiencies in this process are likely multifactorial on the patient, provider, and systems level, however our data suggests that they may be modifiable. Interventions devoted to reducing the time may decrease LOS, reduce cost, improve patient satisfaction, and reduce risk of complications.
Improving care quality for patients with soft tissue and bone sarcoma by establishing a national virtual tumor board and electronic consultation platform.
Authors: Pan Minggui , Fang Andrew , Kavanagh Maihgan , Kim Brian , Lee Jason D , McCormick Craig , Morse Lee Jae , Nag Subir , Nybbaken Grant , Peng Peter , Schwartz Corey M. , Song Joseph , Taggart Denah Renee , Yu Jeanette Cu 
Published: February 2017

211 Background: Bone and soft tissue sarcomas are relatively uncommon and their management is extremely complex requiring coordinated multidisciplinary expertise for optimal care. Because Kaiser Permanente operates across many geographic regions in the country, in-person tumor board is not practical. Methods: The Kaiser Permanente Northern California medical oncology team has developed a system-based virtual tumor board (VTB) and electronic consultation (EC) platform comprised of experts from several key disciplines including musculoskeletal/surgical oncology, musculoskeletal radiology, pathology, radiation oncology, brachytherapy, medical adult and pediatric oncology. The VTB and EC cases are physician referral-based. The VTB occurs once every two weeks via video conferencing reviewing imaging studies and pathology while EC is available for more urgent cases whenever requested. This platform is available to Kaiser Permanente physicians in Northern and Southern California and other states including Hawaii, Mid-Atlantic, Northwest, Colorado, and Georgia. We conducted a survey targeting referring physicians to assess the value of this service platform in improving sarcoma care. Results: From March 2013 to October 2015, approximately 500 cases have been referred to the VTB and EC. Approximately 2/3 of the cases were referred to the VTB and 1/3 to the EC. The cases include a vast spectrum of bone and soft tissue sarcoma cases that were either newly diagnosed or at the time of relapse or progression. The physician survey on the quality and utilization of this sarcoma platform provided very positive feedback, with 100% responses stating that VTB and EC improved patient care and their confidence in managing patients with sarcoma, 90% stating VTB and EC changed their management to a certain extent. Approximately 90% responders rated VTB and EC very to extremely helpful. Conclusions: We conclude that a system-based VTB and EC can provide an excellent platform for improving quality of care and physician confidence in managing patients with bone and soft tissue sarcoma in an integrated healthcare system.
Implementation of a new patient health questionnaire into standard practice in outpatient cancer clinics to improve patient care and quality of treatment.
Authors: Estey Kathryn , Brown Catherine , Perez-Cosio Andrea , Gill Gursharan , Liang Mindy , Liu Geoffrey 
Published: February 2017

214 Background: Patient socio-demographic, lifestyle, and risk factor information at the Princess Margaret Cancer Centre (PM) is routinely collected for clinical purposes. The only standardized patient information presently being gathered in the outpatient cancer clinics at the PM is symptom management data, which is linked directly into the electronic medical records. Collecting and recording additional data can improve the quality of patient care, help identify risk factors, and guide treatment options. Our aim was to determine the feasibility of collecting this additional information in a clinical setting. Methods: This pilot cohort study was implemented in the thoracic outpatient oncology clinic at the PM. It involved developing a questionnaire utilizing literature sources, expert review, and pilot testing. Adult cancer patients completed the questionnaire and a complementary acceptability survey during their first clinic visit. Results: 170 patients with thoracic tumours, primarily lung cancer, took part in the feasibility study. Of these, 51% were female, 67% were Caucasian, and the median age was 65 (range 32 to 88) years old. The acceptability survey demonstrated that: 76% of respondents found that the questionnaire did not make their clinic visit more difficult, 68% found that it asked the right questions, 79% thought the questionnaire contained pertinent information for their doctor and other healthcare providers to know, and 51% found that it was time consuming to complete. Conclusions: This study determined that it is feasible to implement a standardized questionnaire that gathers patient socio-demographic, lifestyle, and risk factor information in routine clinical cancer care. Since half of the study population found the questionnaire time consuming to complete it should be administered prior to patient visits, in an electronic format, and with greater explanation/education. The next phase is converting the questionnaire into an electronic version, which aligns with the preferences of study participants and will allow the information to be more easily accessible by clinicians/researchers.
Molecular testing for colorectal and lung cancer at an academic cancer center satellite site: Opportunities for improvement.
Authors: Marmarelis Melina , Shulman Lawrence N. , Jacobson Joseph O. , Norden Andrew David 
Published: February 2017

229 Background: Given their prevalence, colorectal and lung cancer are treated in both academic and community settings. Appropriate use of targeted therapies in these diseases is challenging given the need for biomarker testing prior to use. Rapidly changing practice standards, limited resources, and barriers to tissue processing make this particularly challenging in the community. We examined the use of biomarker testing and targeted therapies in colorectal and lung cancer at one of the Dana-Farber Cancer Institute satellite sites. Methods: Patients who had their first visit for colorectal cancer between 2011 and 2014 or for lung cancer in 2014 at one site were identified using ICD-9 codes. Notes and reports were reviewed for pathology, staging, molecular testing, and treatment. Results: In 2014, 46 patients had their first visit for colon cancer. MMR testing was done in 48% (22/46) of these patients. Of the 23 patients under 70 years old (NCCN guideline), 75% (17/23) were tested. From 2011 to 2014 there were 30 patients with newly diagnosed metastatic colorectal cancer. KRAS testing was done in 73% (22/30) of these patients and three were subsequently treated with EGFR targeted therapy (all 3 KRAS/BRAF wild type). In 2014, 90 patients were seen with a new diagnosis of lung cancer. Among the 36 patients with adenocarcinoma, 21 were stage IV at diagnosis and 57% (12/21) were tested for EGFR and ALK. The most common reason cited for not testing was tissue sample size (e.g. cytology from pleural fluid, CT-guided biopsy). Among the 9 patients not tested, 6 were noted to have insufficient material and in 3, testing was not requested. Conclusions: The largest discrepancy between guidelines and clinical practice was seen in EGFR and ALK testing in lung cancer. In colorectal cancer there was high concordance with NCCN guidelines and importantly these results appropriately guided EGFR directed therapy. Possible interventions to increase utilization include educational events, reflex testing on pathology, and an algorithm to pursue additional tissue when biomarker testing could significantly change therapy.
Transforming a unit’s culture to improve clinical outcomes.
Authors: Tonne Heidi , Woodrum Theresa , Romano Michael 
Published: February 2017

243 Background: Leadership identified an unhealthy work environment existed in our Oncology Hematology Special Care Unit (OHSCU). This was evidenced by increased turnover, low National Database of Nursing Quality Indicators (NDNQI), and nurse sensitive quality indicator scores. In the fall of 2014 changes were made to the unit with a goal of creating within the unit a culture of clinical excellence, engagement, professionalism, accountability, and improve staff satisfaction. Methods: Leadership met to define the future state of the unit and develop a vision statement. The Quality Manager met with our Unit based Council (UBC) to review data, discuss shared accountability between leadership, and staff and the impact each individual can have on culture and clinical outcomes. Organizational Development facilitated staff focus groups without unit leadership present. Questions asked included: What behaviors would you like to see more or less of? What is your role in supporting change? Focus group results were shared with staff, and guided the development of an OHSCU Guidelines for Professional Behavior. Leadership met with lead staff nurses to discuss their willingness to embrace cultural change and unit vision. Leads completed the Crucial Conversations Class to help them provide immediate, direct, and specific feedback to staff. Leadership met with each staff member to review the guidelines and discuss their commitment to support change. The unit vision was incorporated in all written and verbal communication with staff. Changes in leadership behaviors included increased leadership presence on nights and weekends, daily rounding with patients and staff, and increased amount of positive feedback. Results: Fall injury scores were decreased from 1.55 to 0.25 per 1,000 patient days, target of 0.72. OHSCU has had no catheter associated urinary tract infections (CAUTI) or pressure ulcers in the last 17 months. Patient satisfaction scores have consistently improved over the last nine months. Response of hospital staff scores have increased from 53.6 to 70.9 and currently 90% of patients rate the hospital as a 9 or 10. Conclusions: Through focused efforts and thoughtful actions, it is possible to change the culture of a unit and have a positive impact on quality metrics.