bluuebunny/crossref_metadata_2025_split huggingface dataset:
A radiation oncology peer review program for community hospitals.
Authors: Sturdevant Laurie , Martinez Wendi , Thaker Nikhil , Jhingran Anuja , Kuban Deborah A. 
Published: February 2017

200 Background: Certified Members within the MD Anderson Cancer Network must perform prospective internal review of radiation oncology cases treated at their institution. Since 2009, several Network sites have been systematically added to a quality oversight program. As part of this process, a sample of the internally peer reviewed cases are assessed by radiation oncology Faculty from MD Anderson Cancer Center (MDACC) who are considered disease site experts. Methods: An electronic tool was used by Network sites to enter clinical treatment information on patients undergoing peer review. This case log was used to select a sample size of not less than 10% of each physician’s case load for an in-depth quarterly evaluation by our Faculty. Quality and appropriateness metrics included review of the technical components of the radiation treatment (RT) plan and multidisciplinary management.. RT was scored as being concordant/non-concordant with MDACC or national guidelines. Non-concordant cases were further reviewed for appropriateness given the individualized case. Feedback was then provided by Faculty to the treating radiation oncologists quarterly, to discuss recommendations and practice pattern modifications. Results: To date, 6 of our 13 Network sites are participating in this peer review process with others being phased in. In 2013, we selected 104 of 719 cases entered into our database by the first four sites. 78% (81) of cases were concordant with guidelines, while 22% (23) were non-concordant. Of the non-concordant cases, 23% were deemed individually appropriate but the remainders (17 of 104) were not appropriate. Concordance in the most frequent disease sites ranged from 80 to 89%. In the less frequent disease sites concordance was lower, ranging from 50 to 73%. Conclusions: The highly technical aspects of radiation treatment, the frequent need to integrate a multidisciplinary approach, and the reality that low volume disease sites will need to be increasingly treated in the community accentuate the need for enhanced oversight and more effective consultation with high volume, expert providers. Our study suggests that an integrated approach to peer review can improve the quality and value of cancer therapy in the community setting.
Increasing clinical trial enrollment with the use of incentives in a community oncology practice.
Authors: Blanchard Elizabeth M , Soucy Ann-Marie , Mulvey Therese M. 
Published: February 2017

205 Background: Clinical trials represent a critical component of progress in cancer care, however, enrollment of patients onto adult cancer clinical trials remains disturbingly low at 3-5 percent of patients. In an effort to increase enrollment onto open trials at our center as well as to meet our ACOS requirements, our community cancer center instituted an incentive program to compensate the time medical oncology providers spend enrolling patients onto trials. Methods: In October of 2013 (the beginning of fiscal year 2014), an incentive was given to medical oncologists in our practice if they met an enrollment target of 1% of patients onto trials open at our center. Comparison of enrollment was performed between fiscal year 2014, when the incentive existed, and corresponding months of fiscal year 2013. Results: Enrollment at our center from October 2012-May 2013 was 9 patients with an average of 1.125 per month. For the corresponding period of October 2013-May 2014, when the incentive existed, enrollment was 48 patients, with an average of 6 patients per month. This far exceeded the 1% threshold required to achieve the incentive and has not abated despite the completion of the metric. In addition, enrollment has been similar to unfunded investigator initiated trials and pharmaceutical trials. Cooperative group trials remain limited by lack of funding. All physicians in the group have qualified for the incentive. Conclusions: Incentive programs designed to compensate the time involved with enrolling patients onto clinical trials was very effective in this busy community oncology practice.
Effects of radium-223 dichloride (Ra-223) on risk for hospitalization and health care resource use in the phase 3 ALSYMPCA trial.
Authors: Cislo Paul , Reuning-Scherer Jonathan 
Published: February 2017

21 Background: Ra-223 is a first-in-class alpha-emitter approved for treatment (tx) of patients (pts) with castration-resistant prostate cancer and symptomatic bone metastases. In ALSYMPCA, Ra-223 significantly improved overall survival by 3.6 months vs placebo (pbo) (HR = 0.70; 95% CI, 0.58-0.83; P < 0.001) and was well tolerated. To understand whether the tx benefit corresponds to differences in utilization, hospitalization and other types of health care resource use were evaluated. Methods: Data on hospitalization, nursing home visits, home health care and adult day care services use, and physician visits were captured for each pt. Tx groups were compared, based on percentage needing each type of health care resource, using Fisher’s exact test. To account for differences in each pt resource use in ALSYMPCA, the number of encounters (eg, office visits) and duration of encounters (eg, days hospitalized) were divided by observation time. The mean number and duration of encounters were compared using analysis of variance. To compare tx groups based on the rate of use per year, incidence rates and ratios were calculated using a generalized estimating equation (GEE) regression model. Results: The mean follow-up time in months for Ra-223 vs pbo was 10.0 vs 8.6. The incidence rate for Ra-223 vs pbo was 1.1 vs 1.4 (incidence rate ratio = 0.77; 95% CI, 0.62-0.95; P = 0.013). The mean number of hospitalizations and hospitalization days per year for Ra-223 vs pbo were 1.3 vs 1.7 (P = 0.020) and 8.1 vs 14.6 (P < 0.001), respectively. The percentage of pts that required hospitalization was nominally lower for Ra-223 vs pbo (42.3% vs 49.0%, P = 0.062). Among pts who experienced at least one hospitalization, the mean number of hospitalization days per year for Ra-223 vs pbo pts was 19.4 vs 30.4 (P < 0.001). No significant differences were found between tx groups in terms of visits or durations of time in nursing homes per year, amount of adult day care and home health care services utilized per year, and number of physician visits per year. Conclusions: Compared with pbo, Ra-223 tx resulted in a 23% reduction in incidence of hospitalizations per year and about 6.5 fewer hospitalization days per pt per year. Clinical trial information: NCT00699751.
Improving chemotherapy ordering process.
Authors: Bryant Jill 
Published: February 2017

213 Background: Chemotherapy ordering process can be unsafe and inefficient, putting patients at risk for medication errors. Documentation is essential in decreasing the incidence of errors with ordering and administration. The goal is to provide safe, efficient and quality care to oncology patients. Methods: The aim of the project was to decrease the number of deviations on the chemotherapy order forms by 50% within five months. Deviations identified were documentation inconsistency; checking of chemotherapy dosing at the provider level; and difficulty in updating the original order when changes were required. Large amount of time was spent in reconciling deviations. A multidisciplinary team collaborated on identifying root causes, such as, variances in completion of the forms, knowledge deficit of the ordering process, and staff accepting incomplete orders. Results: Order forms were reviewed and real time observations of the process were conducted. Data was collected on the types of deviations on the forms. The top three deviations were: 1. Lab values were not being completed within seven days; 2. Physician’s name and pager number were not provided; and 3. Order forms were missing the day of the chemotherapy cycle. Interventions included the education in entering complete and pertinent information on orders; institution of same day labs on day of visit; standardizing lab parameters; manual audits; and Nursing education regarding the acceptance of orders with deviations. Prior to intervention, 70% of the chemotherapy order forms had at least one deviation. At the five month evaluation, there was a reduction of 13%. Although a modest decrease, interventions continued. In follow-up, a random sample of orders was reviewed reflecting a reduction of 51%. Conclusions: Interventions continue with anticipation for further improvement in the chemotherapy ordering process. With decreasing the number of deviations, there will be an increase in safe, efficient and quality care for oncology patients. This project showed an initiative of improving a process to provide efficient care throughout the healthcare continuum. [Table: see text]
Applying clinical process analysis in patient access.
Authors: Aranzamendez Gina , Barnes Courtney , Enriquez Eric , Hayes Beverly A , Haywood Valerie , Kaufman Laurie , Quinn Doris , Rohe Duke 
Published: February 2017

214 Background: Patient access is the entry point for new and established patient registration and scheduling process. It serves as the doorway in aligning the need of the patients to the vision of the organization, ensuring financial viability of all parties involved. The increasing demands for regulatory requirements, changes in reimbursement policies, technological and medical advancement, and steep competition, patient access becomes a vital improvement initiative in many healthcare organizations. In FY 2013, our group, the Clinical Process Analysis (CPA) team was tasked to assess the patient access work processes of our clinic areas. Methods: Through a series of structured group interview meetings, the interdisciplinary team (frontline staff, clinical leadership and financial teams) reflects and articulates their current work processes. These work processes are translated into an electronic process map, inclusive of the activities, job roles, estimated times, probabilities, and opportunities for improvement (OFIs). With these elements, CPA delivers a visual display of current work processes which can be utilized for onboarding, visualization of OFIs, and calculation of direct labor cost. A completion of a facilitated PDSA project further infuses the science of improvement. Results: Six centers completed the CPA projects since September 2013. 98 OFIs identified with 91% identified as efficiency and timely issues. 10 PDSA projects initiated, 50% reached completion and 50% are in progress. Clinical teams continue to work on the improvement projects even after the facilitation were completed. Conclusions: Drawing from system thinking and Time-Driven Activity-Based Costing (TDABC) methodology, CPA provides a comprehensive analysis of the current work flow. This allows for both a clinic specific and institutional comparative analysis for identification, implementation and improvement plan. Through facilitation of an interdisciplinary team, from frontline to leadership, process realities are visualized and work-list of opportunities for improvement are identified and worked on. This enables a quality improvement culture of providers and staff to drive quality and financial improvement.
Cost of treatment failure in patients with chronic lymphocytic leukemia: Results of a large U.S. observational study.
Authors: Senbetta Mekre , Robitaille Marie-Noelle , McKenzie R. Scott , Lefebvre Patrick 
Published: February 2017

22 Background: Patients with chronic lymphocytic leukemia (CLL) who eventually experience disease progression are offered a limited choice of treatments. This retrospective observational study assesses healthcare resource utilization and costs in patients with CLL who have received one prior therapy and experience treatment failure (TF). Methods: Adult patients with ≥1 diagnosis of CLL and ≥1 claim for a medication used to treat CLL were identified in the IMS PharMetrics Plus database (01/2008 – 09/2013). Patients were excluded if they had evidence of a non-hematologic malignancy, used a non-CLL antineoplastic agent, or received a stem cell transplant during the 12-month baseline period. TF was identified based on earliest occurrence of one of the following events: initiation of a new treatment for CLL that was not part of the 1st-line therapy, resumption of any CLL treatment following a minimum of 3-month break in treatment, stem cell transplant, radiotherapy, hospital mortality, or hospice care. Resource utilization was reported as monthly incidence rates, and costs were reported in 2013 $US per patient per month (PPPM), comparing patients with and without TF. Results: A total of 6,015 patients with CLL were identified (mean patient age: 63 years old; proportion female: 36%), of which 2,734 (45%) experienced TF. Patients with TF tended to require more OP visits (3.2 vs. 2.5). Average total cost PPPM was $7,850 for patients with TF and $4,555 for patients without TF. The main cost drivers were outpatient (OP) costs ($4,355 for patients with TF; $3,022 for patients without TF) and hospitalization costs ($2,659 for patients with TF; $1,038 for patients without TF). Once adjusted for baseline characteristics, average total cost difference between patients with and without TF was $3,757 PPPM. This difference was largely due to hospitalization (45%) and to OP costs (46%). Conclusions: Patients with CLL experiencing TF appear to require more OP visits and to be associated with higher OP and hospitalization costs PPPM compared to those without TF. These data help in our understanding of the healthcare resource utilization and costs associated with the treatment of patients with CLL.
Application of lean methodology to improve quality and efficiency of molecular diagnostic testing in non-small cell lung cancer (NSCLC).
Authors: Wagman Lawrence David , Maurice John , Crabtree Peggy , Horblyuk Ruslan 
Published: February 2017

220 Background: The advent of targeted cancer therapies has triggered an increase in the volume of molecular testing performed across multiple tumor types. This raises concern about the efficiency of associated operational and quality processes. This study’s objective was to apply lean methodology, using NSCLC as a pilot disease state, to evaluate current molecular testing processes, identify existing inefficiencies, design an improved process and assess scalability for application across other tumor sites at the pilot site. Methods: Modified Lean methodology was employed. Semi-structured 1:1 interviews with multidisciplinary team (MDT) stakeholders representing oncology, pathology, interventional radiology, pulmonology and administration were conducted. MDT-based value stream mapping workshops were carried out to describe the “current” and design the “future” state of molecular testing process in NSCLC. The goal was to identify existing inefficiencies and inform targeted process improvement efforts. Results: Interviews with 25 MDT stakeholders revealed substantial variability in the molecular diagnosis processes and a lack of coordinated communication across disciplinary silos. Specifically, the consensus-derived “current” state map identified appropriate biopsy tissue (quality and quantity) and inconsistent protocol utilization among the major inefficiencies resulting in repeat biopsies. Development and implementation of the MDT-based molecular testing protocol, including introduction of a tissue acquisition protocol, were identified as target areas for process variability improvement. Conclusions: Inefficiencies exist in molecular testing processes and need to be identified and minimized as the burden of molecular testing increases. This pilot successfully employed modified Lean methodology to identify areas of improvement in the molecular testing process in NSCLC and could be replicated in other relevant disease states. Program evaluation is underway to quantify the impact of this initiative on operational and patient care metrics.
Sharing experiences and building collective projects in quality management: The strength of UNICANCER group.
Authors: Sieradzki Gregory , Esperou Helene , De Jesus Anne 
Published: February 2017

226 Background: UNICANCER is a hospital group entirely devoted to fighting cancer. UNICANCER groups together 20 French Comprehensive Cancer Centers (FCCC), which are private, non-profit establishments with a threefold mission of patient care, research and oncology teaching. They share the same organizational model to take care the patients and they have organized an informal network of quality and risk management In 2005, the FCCC federation (former Unicancer group) was created a Quality department in order to build a common approach to improve the quality of care and patient management in Cancer Centers. One the most important tools to set up this shared works were comparative analysis and feedback system. Methods: Every year, the quality department of Unicancer group coordinated the results of several indicators recorded by each centers. These results were summarized in the benchmarks dashboards to identify the priority actions for the group. Results: Between 2006 and 2014, some collaborative projects have been carried out in various fields: (1) development of the culture of continuous improvement, (2) involvement to the national implementationof hospital quality and safety indicators in France, (3) development of specific indicators of cancer care, (4) implementation of questionnaire survey to assess the in- or outpatient satisfaction. As far as concerned the different results of external assessment (1) the values of quality and safety indicators are above the national average, (2) the Cancer Centers have the best level of “certification” for the French National Authority for Health. Conclusions: The teamwork and benchmarking is an innovative way of working. The level of quality of care and patient management increases steadily in Cancer Centers in France. The next step consists of developing a common standard to keep competitive edge. [Table: see text]
Quality of care study in the surveillance of curable colon cancer.
Authors: Bhardwaj Aarti Sonia , Holcombe Randall F. 
Published: February 2017

237 Background: The 2005 ASCO surveillance guidelines for Stage II/III colon cancer recommended chest, abdomen (and pelvis) imaging annually for 3 years, checking a CEA every 3 months for the first 3 years and colonoscopy 1 year after surgery or preoperatively. Our primary aim was to determine Mount Sinai Hospital’s (MSH) compliance rate with ASCO surveillance guidelines, with a goal of achieving 80% compliance. We hypothesized a bias to over-imaging. A secondary aim was to determine the frequency at which high risk Stage II patients were referred to medical oncology. Methods: A retrospective study of 118 patients with newly diagnosed stage II or III colon cancer at MSH in 2011 and 2012 was undertaken. Results: Compliance rates for early surveillance measures included. 1. Checking CEA approximately every 3 months: Stage II - 84%; Stage III - 88%. 2. Colonoscopy guidelines: Stage II - 72% and Stage III - 94%. Imaging post surgery or adjuvant treatment: Stage II - 48% and Stage III - 70%. Subsequent imaging: Stage II - 44%; Stage III - 28%. (See Table.) Overall compliance with early surveillance guidelines was 55% for Stage II patients and 83% for Stage III patients. All of the non-compliance for subsequent imaging was due to overscanning. Only 62% of high risk Stage II patients were referred to medical oncology. Conclusions: Our baseline compliance to early surveillance measures for colon cancer did not consistently achieve our pre-specified benchmark. Specific areas of improvement include avoidance of overscanning during colon cancer surveillance after adjuvant chemotherapy and an improved rate of referral of high risk Stage II patients to medical oncology after surgery. [Table: see text]
Evaluating oncology pharmacist safety reporting in an outpatient cancer center.
Authors: Blouin Gayle C. , Chio Christine , Kim E. Bridget , McGladrigan Conor , Bohlen Nie , Lafleur Katie 
Published: February 2017

238 Background: Safety reporting is imperative because it provides an opportunity to identify and address preventable errors to enhance patient safety. Pharmacists at the Massachusetts General Hospital cancer center have historically submitted the highest number of safety reports compared to clinicians/nursing. This past year, however, there was a decline in the number of reports submitted. Because pharmacists are in a key position to monitor patient safety, this study was conducted to characterize safety reports submitted by pharmacists and describe subsequent action plans. Additionally, pharmacists’ attitudes towards safety reporting were assessed and obstacles identified. Methods: A retrospective analysis of medication safety reports submitted by outpatient staff over the past 4 years was conducted. Data were obtained from institutional safety reporting system. Pharmacy procedures and education materials were compared against safety reports. Pharmacists’ attitudes were assessed using online survey adapted from the AHRQ. Results: Pharmacists consistently submitted more safety reports compared to other disciplines. However, safety reporting declined from a mean of 61 reports annually to 40 in 2013. The majority of reported events involved prescribing errors, followed by orders submitted to pharmacy without meeting treatment criteria. Actions plans included: protocol checklists, staff education and updating order sets. The majority of pharmacists surveyed agreed/strongly agreed that the practice is actively doing things to improve patient safety and mistakes have led to positive changes. When an event is reported, almost 50% of pharmacists indicated infusion unit staff perceive the person is being written up, not the problem. Common barriers to reporting were time constraints, nurses taking reports personally and not knowing which events warrant reporting. Conclusions: Pharmacists at our institution play an integral role in safety reporting which is essential to provide quality patient care and enhance patient safety. Obstacles identified in this study may have contributed to the recent decline in reporting. Opportunities exist to reinforce non-punitive nature of safety reporting.