bluuebunny/crossref_metadata_2025_split huggingface dataset:
Social disparities in perceived coordination of care and use of chemotherapy among patients with stage III colorectal cancer.
Authors: Morris Arden M. , Griggs Jennifer J. , Davis Rachel , Banerjee Mousumi , Abrahamse Paul , Ward Kevin , Kato Ikuko , Hawley Sarah T. 
Published: February 2017

24 Background: Our prior work demonstrated low uptake of chemotherapy among advanced stage rectal cancer patients and significantly lower uptake among minorities. Underuse of chemotherapy is associated with decreased survival. In this analysis, we hypothesized that health system factors such as inadequate coordination of care contribute to under-use of chemotherapy among minority and low socioeconomic status (SES) patients. Methods: We performed a population-based survey of all stage III colorectal cancer patients diagnosed in the State of Georgia and Metropolitan Detroit SEER catchment areas. Our outcomes of interest were perceived care coordination and self-reported use of chemotherapy. Independent variables included clinical and demographic factors. We used chi square analyses to assess associations between patient characteristics, coordination of care, and use of chemotherapy. Multiple linear regression examined relationships between SES, coordination of care, and use of chemotherapy after adjusting for age, sex, and comorbidity. Results: In preliminary analyses, 215 patients have completed the survey (initial response rate of 60%). To date, most participants have reported good-to-excellent coordination of care (mean=4.3 on scale of 1-5), and care coordination did not differ by clinical or demographic factors. Those who perceived better care coordination were more likely to receive chemotherapy (p<0.001). Respondents with high school education or less had significantly lower uptake of chemotherapy relative to their counterparts (71% vs. 89%, p=0.005), and this difference was significant even when adjusting for coordination of care. Conclusions: SES, in particular education level, was associated with both coordination of care and with receipt of chemotherapy. If these findings are confirmed in our larger sample, we will be able to identify targets for health system intervention and improvement.
Use of diagnostic testing for patients with early-stage breast cancer in a multi-hospital quality collaborative in Michigan.
Authors: Breslin Tara M. , Kubus James , Ali Haythem Y. , Singh T. Trevor , Adams Paul T. , Applewhite Angela , Mehringer Ann M. , Silver Samuel M. 
Published: February 2017

242 Background: In 2012, ASCO identified five opportunities to improve the quality of cancer care and reduce costs. Two of these recommendations focused on limiting use of advanced diagnostic imaging with computed tomography (CT), Positron Emission Tomography (PET), and radionuclide bone scans (BS) at diagnosis and during surveillance for women with early stage breast cancer with a low risk of metastasis. We describe the use of diagnostic imaging among patients with early stage breast cancer treated at hospitals in Michigan. Methods: The Michigan Breast Oncology Quality Initiative is a collaboration between Michigan hospitals, the University of Michigan Comprehensive Cancer Center, and the National Comprehensive Cancer Network (NCCN). This collaborative collects longitudinal demographic, staging, treatment, and follow up data using the NCCN Breast Outcomes Database platform. We analyzed use of advanced diagnostic testing with CT, PET, BS and contrast it with use of traditional imaging (mammography/ultrasound) at diagnosis and during follow up in patients with stage 0, I, II breast cancer between 1998 to 2009. Patients who died or recurred were excluded. Results: The cohort included 7,632 patients (19.6% stage 0, 48.1% stage I, 32.3% stage II) treated at 17 hospitals. Use of traditional imaging was documented in nearly 100% of patients at diagnosis and throughout the follow up period. With respect to advanced diagnostic imaging, 20.3 % underwent CT, 4.7% underwent PET, and 11.6% underwent BS at diagnosis. Advanced testing use decreased over time (Table). Conclusions: Despite published guidelines, which recommend against their routine use, advanced diagnostic imaging use was prevalent among patients treated for early breast cancer at MiBOQI hospitals. Education efforts should target physicians and patients on the lack of proven benefit and potential risks of using advanced diagnostic imaging in this population. [Table: see text]
Development of quality indicators for treatment of ductal carcinoma in situ (DCIS) of the breast using a multidisciplinary Delphi process.
Authors: Quan May Lynn , Ghali William , Craighead Peter S. , Bryant Heather E. 
Published: February 2017

248 Background: Ductal carcinoma in situ (DCIS) of the breast accounts for ~30% of new breast cancer diagnoses. Measuring quality of DCIS treatment is problematic due to its distinctively different clinical behaviour from invasive breast carcinoma, where standard outcomes such as mortality are not relevant. Therefore, we sought to develop clinically relevant quality indicators to evaluate treatment of DCIS. Methods: A Delphi consensus process was undertaken using a multidisciplinary panel of nine clinical and methodologic experts from Ontario, Alberta, and British Columbia. Panel members were nominated based on membership in provincial breast tumour site groups. Four criteria for a good quality indicator were used; the indicator measures a treatment that benefits the patient, there is support from scientific literature or professional consensus for benefit; the indicator is under control of the health care provider, the indicator is extractable from the medical record. Candidate indicators were identified from published clinical practice guidelines in North America. Three iterations of ratings using Likert scale rankings were utilized to identify final quality indicators, which were then prioritized. Results: A total of 10 candidate indicators were identified from four clinical practice guidelines encompassing the diagnosis, surgery and adjuvant treatment components of DCIS. A total of eight indicators were identified and prioritized (Table). Conclusions: We successfully developed practical quality indicators for evaluating the treatment of DCIS, which can be used in any jurisdiction to measure key performance benchmarks and identify variations in care warranting intervention or improvement. [Table: see text]
The oncology palliative care matrix: A community-derived evaluation tool for constructing oncology palliative care programs.
Authors: Padgett Lynne 
Published: February 2017

253 Background: While the Institute of Medicine and the Center to Advance Palliative Care have provided the impetus for many cancer centers to build palliative care programs, guidance regarding the “nuts and bolts” of program development is lacking. The Oncology Palliative Care Matrix (OPCM) is a unique self-assessment tool designed to facilitate both program evaluation and planning for provision of oncology palliative care. Methods: The National Cancer Institute Community Cancer Centers Program (NCCCP) Palliative Care Working Group developed the OPCM to assess palliative care capacity. The tool covers 17 components associated with quality palliative care delivery (e.g., staff training, patient identification, advanced care planning, attention to spiritual care). All NCCCP sites (16 enrolled in 2007, 14 enrolled in 2010) completed the matrix in 2010 evaluating their capacity with respect to each of these domains at the following time points: baseline (entry to the NCCCP program), 2 years after NCCCP enrollment (2007 sites only), and the upcoming year (goals for the future). Results: At baseline, matrix responses reflected variability in service capacity across the 17 domains. Reported capacity for specific palliative care components improved for the 2007 sites after 2 years in NCCCP; all sites identified ‘reach’ goals for the coming year. For example, at baseline, 63% of 2007 sites and 50% of 2010 sites referred only patients at end-of-life or with advanced disease and severe symptoms for palliative care services. However, after 2 years in NCCCP, 44% of 2007 sites still referred only these patients, while 56% made referrals to palliative care for patients at all cancer stages and/or as needed during post-treatment. Further, 100% of 2007 sites and 86% of 2010 sites aspired to this expanded referral capacity in the future. Conclusions: The OPCM shows utility in the community setting for self-assessment of capacity and strategic planning to improve quality palliative care delivery. It also highlights that some components of quality care may be easier to achieve/improve (e.g., referral for palliative care) than others (e.g., regular symptom assessment, palliative care staff support).
Treatment trends for stage III non-small cell lung cancer for noninsured patients compared with other types of insurances: A National Cancer Database analysis.
Authors: Abou El Ezz Khaled , Olson David Charles , Silberstein Peter T. 
Published: February 2017

262 Background: This study investigated trends in management of stage III NSCLC in patients with no insurance versus other insurance types using the National Cancer Database (NCDB). Methods: 281,277 patients with Stage III NSCLC were identified from 2000 to 2009 using the NCDB. Reported use of surgery, radiation, chemotherapy, or no treatment were analyzed by insurance status. Results: Radiation/chemotherapy was most often used to treat stage III NSCLC among non-insured (41.7%), Medicare (31.3%), Medicaid (42.3%), and private insured patients (43.9%). Non-insured were just as likely to receive radiation/chemotherapy as Medicaid (41.7% vs. 42.3%, p=0.36) but less likely than privately insured (41.7% vs. 43.9%, p<0.001). Non-insured were more likely to receive no treatment than privately insured (20.8% vs. 11.7%, p<0.001) and Medicaid (20.8% vs. 16.8%, p <0.001) but less likely than Medicare (20. 8% vs. 24.6%, p<0.001). Tri-modality treatment was given less often to non-insured patients than privately insured (4.6% vs. 10.2%, p<0.001) and Medicaid (4.6% vs. 6.2%, p<0.001) but more often than Medicare patients (4.6% vs. 3.7%, p<0.001). Conclusions: Stage III NSCLC was most often given chemotherapy/radiation regardless of insurance status. Non-insured patients received this treatment as often as Medicaid but less often than privately insured. Non-insured patients also received no treatment more often than Medicaid and privately insured and less often than Medicare. Future studies could examine if average age among the populations impacted these findings. [Table: see text]
National Radiation Oncology Registry: The pilot prostate cancer registry.
Authors: Efstathiou Jason Alexander , Nassif Deborah , Chen Ronald C. , Hoffman Karen Elizabeth , Kuban Deborah A. , Lawton Colleen Anne , Michalski Jeff M. , Potters Louis , Rose Christopher M. , Sandler Howard Mark , Suh Warren , Wall Terry , Zietman Anthony L. , Bekelman Justin E. 
Published: February 2017

267 Background: The National Radiation Oncology Registry (NROR), sponsored by the Radiation Oncology Institute and the American Society for Radiation Oncology, is building a nationwide electronic infrastructure to collect standardized information on cancer care delivery among patients treated with radiotherapy in the United States. The NROR pilot registry will focus on patients with prostate cancer (PCa). Methods: Since October 2010 the NROR has undertaken four main efforts (1) stakeholder engagement, including hosting a forum with ongoing opportunities for feedback from patients, clinicians, payers, vendors, and federal agencies; (2) electronic infrastructure development to facilitate transfer of information from disparate clinical systems to a database model designed for efficient aggregate analysis; (3) data dictionary development with guidance from PCa and technical experts, and health services researchers; and (4) pilot site engagement, in which over 80 clinical centers indicated willingness to participate in the pilot registry by filling out an online survey. Results: The stakeholder forum revealed enthusiasm for the NROR and emphasized the need for patient-centered outcomes, minimal data burden, and maximal connectivity to existing registries and databases. In partnership with Healthcare IT, Inc, the NROR is building an electronic infrastructure to provide connectivity across radiation oncology and hospital information systems. The data dictionary provides standardized data elements in seven domains: facility characteristics, physician demographics, patient demographics and comorbidity status, radiotherapy technical data for external beam and brachytherapy, hormone therapy details, clinician- and patient-reported outcomes. Up to 30 clinical centers will be selected to serve as pilot sites through an objective, blinded, and transparent process. Pilot registry endpoints include percentage of eligible patients enrolled, percentage of data elements captured for each participant, determination of barriers to participation, and patterns of care delivery. Conclusions: The NROR pilot study will provide the framework for expansion to a nationwide electronic registry for radiation oncology.
Matching physician resources with demand in a cancer hospital emergency center.
Authors: Terrell John Allen , Todd Knox H. , Burke Laura 
Published: February 2017

276 Background: In early 2010 the Emergency Center (EC) at MD Anderson Cancer Center identified a need to adjust the physician staffing to better meet the demand of increasing patient work-load and improve physician satisfaction. There was also a strong interest in learning more about variations in work methods and how physician time was spent in the EC. Methods: The EC partnered with the Office of Performance Improvement (OPI) to perform a work sampling study and analyze how physicians’ time is spent by physician, time of day, and day of week. Also needed to properly match resources to demand was how the patient demand varied with time of day and day of week. Before the study was performed the tasks and categories of interest were established and training as well as a measurement study to ensure consistency from one data collector to another. A sampling plan and method were then developed to identify and record the frequency of tasks performed to be studied by shift, day, and physician. Patient data was collected through the internal computerized whiteboard to identify patient arrivals and occupancy. Results: The results showed the variation in tasks performed was most highly attributable to the individual physician rather than time of day and day of week. Percentages of the shifts were calculated, summarized, and presented to the EC leadership. This data was then combined with the patient volumes data in an interactive spreadsheet to simulate different scheduling patterns and provide recommendations to best match resources with workload. Conclusions: The project provided a valuable resource to contribute to identifying the best scheduling pattern for the EC including start times and shift length. The results have been further used to strive towards inter-physician consistency over the past two years and have led to additional studies and opportunities for improvement. By using a data based methods, even for qualitative studies, important process understanding and opportunities are available which can help break through barriers and improve data based decision making in health care.
Use of palliative care measures to support improved patient outcomes and quality of life.
Authors: Williams Ken , McBride Tilithia 
Published: February 2017

281 Background: Key public-private quality improvement entities, such as the National Quality Forum (NQF) and the National Priorities Partnership, have identified palliative care measures as being critical for the care of cancer patients. In this study, Avalere sought to understand whether current palliative care measures are adequate to support desired patient outcomes, including quality of life. Methods: Avalere conducted searches of large, national quality measure databases—including the Agency for Healthcare Research and Quality’s National Quality Measure Clearinghouse and NQF—as well as public quality measurement programs to better understand the range of existing palliative care measures and the use thereof. In addition, Avalere augmented this research through a review of the white and grey literature to determine how such measures may be better used to support desired outcomes. Results: Several organizations—most notably the American Society of Clinical Oncology (ASCO); the American Medical Association–convened Physician Consortium for Performance Improvement, with the National Comprehensive Cancer Network and ASCO; and the RAND Corporation—have developed measures addressing palliative care for cancer patients. Several of these measures have been subsequently endorsed by NQF. Despite this, few palliative care measures have been incorporated into national quality measurement programs, outside of ASCO’s proprietary Quality Oncology Practice Initiative (QOPI). Conclusions: While it is widely acknowledged that palliative care measures are critical for the care of cancer patients, particularly as it relates to supporting quality of life, little has been done to ensure such measures are incorporated into national public quality improvement initiatives, such as the Centers for Medicare & Medicaid Services’ Physician Quality Reporting System. As calls for increased use of patient-reported outcomes and other palliative care measures continue to rise, policymakers may need to consider incorporating existing, NQF–endorsed measures, such as those used in QOPI, into public programs.
Data-driven transformation to an oncology patient-centered medical home.
Authors: Sprandio John David , Flounders Brian , Lowry Maureen R. , Tofani Susan Higman 
Published: February 2017

285 Background: Consultants in Medical Oncology and Hematology (CMOH) implemented an EMR in 2003. It fell short in the compilation and presentation of meaningful data upon which to base clinical decisions. CMOH created a new workflow and effectively integrated the EMR with a practice-developed clinical decision support software (CDSS) called Iris. Methods: A project team outlined the data sources required in making a clinical decision and reviewed staff workflow. Within six months, they developed a system for displaying data from internal and external sources into a single scrollable screen for use by the physician at the point of care. Results: Iris promotes a rapid-learning cycle that results in 1) improved adherence to NCCN guidelines; 2) enhanced access and continuity of symptom management; 3) enhanced communication, tracking, and coordination of care; 4) reduction in ER utilization/hospital admissions; 5) a performance status driven approach to end of life care; 6) a systematic measurement of physician performance. This approach enabled CMOH to meet the NCQA’s criteria for level III Patient-Centered Medical Home in 2010. Conclusions: Implementation of EMRs alone does not improve health care delivery. Rather, it is the merger of clinical operations workflow and technology infrastructure delivering consumable data to providers that drives quality improvements and enhancements to the value of cancer care. [Table: see text]
Telehealth for oncology genetic counseling: An Idaho experience.
Authors: Eichmeyer Jennifer N. , Zuckerman Dan Sayam , Beck Thomas M. , Camilo Nicolas , Mark Kevin , Barbera James , Bradshaw Nicole , Greenburg Brett , Johnson Devan 
Published: February 2017

288 Background: Access to qualified genetics specialists continues to be a barrier for patients in rural settings. Our institution aimed to develop a proof-of-concept telehealth program that supports the vision of transforming the way healthcare is delivered specific to Idaho. Methods: Based on a needs assessment with 40 direct caregivers the program was designed to eliminate inconsistency and variation through the system and expand the specialty care footprint from the tertiary care hospital. To gain traction, specific areas (genetic counseling and nutritional counseling) were identified that could move forward with telehealth. This small-scale implementation could be rapidly executed using few system resources while providing feedback for future refinement and expansion. Technology needs included, Microsoft Lync, a HD web camera, USB speaker/microphone, dual monitors, and a document camera to be added to workstations for the provider. A transportable cart with computer and dual monitor workstation was assembled for the outreach site with the same technology components. The metrics chosen to track the benefits of this service included: provider travel time and costs, elapsed time from referral to first scheduled appointment, comparison of patient volumes, and patient satisfaction. Satisfaction measures were collected by written questionnaires and interviews with the patient. Results: During a 3-month period 23 genetic counseling appointments were conducted by telehealth. This resulted in a savings of $1050.63 in mileage and travel wages and 13.5 travel hours. Wait times for appointments dropped from 23 days to 16 days, and appointment volumes increased from 6/month to 8/month. Access to services increased from 8 hours per month to 16 variable hours per month with the availability of immediate needs appointments. Patient scores (N=12) demonstrated “Excellent” ratings (5/5) in the following: 83% satisfaction using the telehealth cart, 83% likelihood to use telehealth again, and 92% recommend telehealth to a friend. Conclusions: Improved convenience, access, and cost savings while providing high quality care were maintained using telehealth. Expansion of the program to another outreach site has already been approved by leadership.