bluuebunny/crossref_metadata_2025_split huggingface dataset:
Systematically implementing an electronic platform to improve patient experience measurement in Ontario, Canada.
Authors: Moody Lesley , Dhanju Suman , Benn Sarah , Olaru Isabela , Sliz Nadia , Snow Amy , Khan Sara , Singh Simron 
Published: April 2017

111 Background: Cancer Care Ontario organizes and ensures quality cancer care for 13.5 million residents in Ontario, Canada and is systematically deploying a web-based tool, called Electronic Patient Reported Experience Measures (ePREM), through a touch-screen platform previously deployed within Regional Cancer Centres (RCCs). ePREM has been used to disseminate the first patient reported experience measure (PREM), called Your Voice Matters (YVM). YVM will be collected on all patients in Ontario undergoing cancer treatment in real time, creating the largest known, linkable patient experience dataset. Methods: Implementation feasibility and readiness was assessed across all 14 Regional Cancer Programs through a provincial assessment which informed the phased implementation. Implementation was rooted in a change management framework: clinical and administrative champions, available resources, existing technical environment and competing program priorities. In March 2016 a four-wave implementation was initiated controlling for readiness and centre volumes, with a focus on extensive stakeholder engagement, tool training, launch and operational support. To date, ePREM is fully operational in 10 of 15 RCCs. Results: Provincial deployment was 66% complete in October 2016. By March 2017 full provincial implementation will be complete. Successful implementation has been directly linked to an adaptive design within the implementation and change management framework as a four-wave roll out. Key factors included: multi-faceted communications with centre leadership, and implementation teams. During this initial data stabilization phase, there were 9,266 completed surveys submitted and 10,932 partial survey responses submitted. Conclusions: PREMs are appropriate quality improvement indicators for cancer patients within the treatment phase. ePREMs enables systematic, linkable collection of real time PREMs to improve the patient experience in Ontario and contribute to the planning of new initiatives. Upon full provincial implementation ePREMs will allow for the largest known dataset of PREMs. Successful implementation has been directly linked to an adaptive, four-wave approach.
Reviewing deaths within 30 days of systemic anti-cancer therapy: Driving quality in a regional chemotherapy service.
Authors: Forde Caroline , Scullin Paula , Edgar Lynne , McAleer James J , Coyle Victoria M 
Published: April 2017

112 Background: Systemic anti-cancer therapy (SACT) administration rate at the end of life has been deemed a key metric for assessing quality of cancer care. A structured peer review process has been developed within the Cancer Centre, Belfast City Hospital, to discuss all patient deaths occurring within 30 days of SACT across Northern Ireland at a monthly, multidisciplinary, educational mortality meeting. We aimed to review cases discussed, characterising patients, causes of death and the role of SACT in patients’ deaths. Methods: A retrospective analysis was undertaken of 282 solid tumour patients, whose deaths were discussed at the mortality meetings from January 2013 to August 2016. Results: The 30-day mortality rate for the Cancer Centre was 4.5%. Most commonly represented tumour sites were gastrointestinal (39%), lung (22%) and breast (17%) with 96% receiving palliative treatments. WHO Performance Status (PS) was 0-2 at final SACT cycle in 83% (8% PS 3, unknown 9%). 43% of patients were receiving their first cycle and 56% receiving first line treatment for advanced disease. 77% of deaths occurred in hospital with 57% attributed to progressive disease. Other causes of death included infection (7% neutropenic, 11% non-neutropenic) and thromboembolism (12%). In 10% SACT was deemed to have caused or hastened death whereas in 65% SACT was non-contributory. In 25% SACT did not play a major role, but a contributory role could not be confidently excluded. Conclusions: SACT related death rate appears comparable to other institutions’ published routine outcomes. Robust review of SACT mortality encourages service improvement and individual reflection. Prescribers are reminded of the critical importance of carefully balancing patients’ needs and concerns with realistic outcomes and treatment risks, particularly in heavily pretreated or poor PS patients. Case discussions have generated service improvements including site and regimen specific prepopulated consent forms, a standardised SACT assessment proforma and mandatory response assessments as part of SACT protocols. Neutropenic sepsis remains the leading cause of SACT related mortality and further innovative improvements in care are required.
Hard-wiring survivorship care plan delivery.
Authors: Barbarotta Lisa , Jauk Mae Anne , Chiang Anne C. , Sanft Tara Beth 
Published: April 2017

113 Background: As outlined by the Institute of Medicine (IOM) report, ASCO, the Commission on Cancer, survivorship care planning is an essential part of quality cancer care. Meeting SCP delivery standards is a challenge due to complex systems, difficulty identifying eligible patients, lack of clarity around roles and responsibilities, and time required to complete the care plans. Yale Cancer Center/Smilow Cancer Hospital is a NCI-designated comprehensive cancer center with 12 multidisciplinary cancer programs, a large cancer hospital and 10 care centers in the community. We have approximately 4000 early stage analytic cases per year. We set out to standardize SCP delivery. Methods: A group of multidisciplinary stakeholders convened to outline goals and identify needs. Based on gap analysis and review of national standards, a standard operating procedure for the creation and delivery of SCPs was developed. Models of care were outlined in the policy. Disease specific treatment summary and care plan templates for the most common cancer types were developed within our electronic medical record (EMR) based on ASCO standards and were vetted by disease team experts. The templates were built to minimize the need for manual entry of content. Automated alerts were developed within the EMR to trigger identification of eligible patients. An operational plan was developed for each clinical area to outline responsibilities for care plan creation and delivery. Results: Implementation of model survivorship care within each disease team and community site was performed over a period of one year. The number of care plans delivered has already increased by 20%. At least 10% of early stage analytic cases received SCPs in 2015. Conclusions: Meeting SCP standards in a large, single institution can be challenging. With a standard operating procedure, clear delineation of responsibility within teams, disease specific templates, and EMR tools to trigger visits, meeting these standards becomes an achievable goal. A systematic approach to developing comprehensive survivorship care in a large academic center can hardwire high quality patient care and compliance with standards.
Creating an educational quality improvement program for radiation oncology residents in McGill University.
Authors: Pembroke Catherine Anne , Biron Alain , Alfieri Joanne 
Published: April 2017

118 Background: Quality insurance (QI) is a pillar of good clinical governance and is at the centre of modern health care. The Royal College of Physicians and Surgeons of Canada CanMeds 2015 have now mandated that QI should be taught and the competencies assessed in all post-graduate residency programs. To our knowledge, this is the first attempt to create a post-graduate QI curriculum amongst radiation oncology trainees. We aim to describe the feasibility of introducing these professional skills which should be integral to every training program. Methods: A QI team has been created within the department of Radiation Oncology at McGill University consisting of a clinical fellow and 3 staff physicians. QI teaching will take place in a longitudinal manner with the mandatory curriculum divided into foundation, intermediate and advanced competencies depending on years of seniority. Teaching is delivered by a combination of two academic half days, consisting of didactic lectures and practical workshops, and self-directed online modules. Each resident during the intermediate years (PGY2-4) will complete a QI project in 9 months under the supervision of an attending physician. The resident will become well versed with QI tools and techniques by presenting their project at specific 3-monthly time points to their supervisor and QI team. In June we will host a QI day where a QI scholar will be invited to teach, each resident will present their project and merit prizes will be awarded. Formal mandatory assessments will take place with a combination of self-assessment, QI- knowledge based assessments (QI-KATs) and balanced score cards. Results: The curriculum has been developed with input from McGill University curriculum and assessment experts. This is a pilot program for the academic 2016/17 year. We are currently meeting our pre-defined milestones. The program will be formally evaluated and adapted to ensure sustainability. Conclusions: The QI skills gained will enable the individual to maintain the highest standards throughout their subsequent careers. A robust, interactive, sustainable curriculum will ensure that this is delivered effectively within radiation oncology and act as a model for all residency programmes.
Reducing invasive fungal infections in patients with acute myeloid leukemia receiving induction and re-induction chemotherapy at the University of Virginia Health System.
Authors: Naeem Mohammed Athar , Morris Amy , Murray Torey , Thomas Tanya , Degregory Kathlene , Cox-Hall Heather , Lewis Jessica D , Bal Anjali , Daniels Elizabeth , Keng Michael Kenneth 
Published: April 2017

120 Background: At the University of Virginia Health System (UVaHS), antifungal prophylaxis was not routinely given to patients undergoing induction and re-induction chemotherapy for acute myeloid leukemia (AML) from 7/2011 to 9/2015. A retrospective chart review of 179 patient encounters identified a 19.7% rate of proven or probable invasive fungal infection (IFI); national averages for IFI are 8-10% in this population. Methods: To target an IFI rate of less than 10%, a multidisciplinary team comprised of oncology and infectious diseases physicians, clinical pharmacists, nurses, and information technology specialists was formed. Through participation in the 2016 ASCO Quality Training Program (QTP), the group developed current and ideal state process maps, a Pareto chart, and a priority matrix to determine an action plan. The group identified the most common problems contributing to IFI: inconsistent definition of IFI, no routine antifungal prophylaxis, and lack of education for the health care team. Results: From 9/2014 to 8/2016, the first PDSA cycle consisted of physicians ordering antifungal prophylaxis on an ad hoc basis, resulting in 11.7% IFI in 77 total patient encounters. During the second PDSA cycle starting in 8/2016, a clinical practice guideline standardized the definition of IFI and appropriate antifungal prophylaxis. Physicians, nurses, and pharmacists were educated on the new standard work. PDSA Cycle #2 is ongoing. As of 11/2016, zero of 8 patient encounters had an IFI. To ensure sustainability of the quality improvement study, monthly electronic medical record reports will capture guideline compliance, specifically the use of antifungal agents, and track future IFI. Future data will be statistically analyzed. Conclusions: Using quality improvement methods learned at ASCO QTP, a multidisciplinary team developed an action plan which to date has shown a clinically significant reduction in IFI; this outcome may lead to decreased hospital length of stay and improved patient quality of life. Further PDSA cycles are scheduled and continuous evaluation of the process is ongoing.
A needs-based curriculum for hematology/oncology mid-level providers.
Authors: Binder Adam , Odea Denise , Malone Adriana Kaczaraj 
Published: April 2017

121 Background: Mid-level providers, both nurse practitioners and physician assistants have comprehensive clinical training, however, they do not undergo in depth sub-specialty training prior to working within a sub-specialty practice. In addition, at our institution, often they are not integrated into academic culture resulting in dissatisfaction with educational opportunities. As a result, we set out to develop a needs based curriculum in order to provide focused learning opportunities for our mid-level providers and improve their satisfaction with the educational environment. Methods: An initial survey was sent to all mid-level providers within the division of hematology and oncology at a single institution. The survey evaluated attendance to currently available lecture series, satisfaction with the educational environment, and an assessment on practitioner comfort level in managing 19 clinical conditions commonly seen in oncology patients. All responses were voluntary and anonymous. A lecture series was developed focusing on topics in which providers felt least comfortable. Follow up survey was to be conducted after 6 months and 1 year of the educational lecture series. Results: On average 11 providers attended each lecture. After 6 months of lectures, there was a suggestion that more practitioners were satisfied with educational opportunities at our institution (pre-intervention 0% (N = 15) satisfaction, at 6 months 43.75% (N = 7)). There was no suggested change in comfort level in managing the specific clinical conditions. Mid-level providers, in addition to attending the focused educational lecture series, were more likely to attend other educational lectures within the institution. Conclusions: At interim analysis, our educational intervention seems to have improved mid-level provider satisfaction with educational opportunities provided to them. In addition, there has been an unintended effect of improving their attendance at other lecture series offered, implying that they feel more integrated into the academic community. To date there is no suggestion that the curriculum is improving providers comfort level in managing the pre-defined clinical scenarios.
Harmonization of patient-reported outcomes into EHRs at four cancer hospital outpatient clinics for patient care and quality assessment.
Authors: Chung Arlene , Stover Angela M. , Wagner Lynne I. , LeBlanc Thomas William , Topalaglu Umit , Zafar Yousuf , Zullig Leah L. , Smeltzer Phil , Basch Ethan M. 
Published: April 2017

129 Background: Patient-reported outcome (PRO) measures are well established in oncology trials but are not collected systematically during clinical care, to guide symptom management, or to assess quality. A growing body of evidence shows that collecting PROs during cancer care yields better clinical outcomes. Yet, little is known about best practices for PRO integration into electronic health record (EHR) workflows. We report on the first cross-institutional effort for PRO data harmonization across four CTSA-funded institutions (University of North Carolina at Chapel Hill, Wake Forest University, Duke University, Medical University of South Carolina). Methods: Through surveys, systematic stakeholder qualitative focus groups, a landscape analysis, and technical/workflow assessment, our cross-institutional team sought to: 1) determine a set of common PRO measures to be collected via patient portals tethered to EHRs across the 4 sites; 2) develop an implementation strategy for the collection of PROs via patient portal within clinical workflows; and 3) collect a common set of PROs in cancer clinical care. We also sought to develop the methodological steps to harmonize extracted PRO data across each site to each other and then to the PCORnet Common Data Model Common Measures for PROs across each site. Results: Across the four sites, each institution uses Epic Systems (EHR and patient portal) and had available a library of PRO questionnaires which included the PROMIS profile (29 items) and short forms, SF-20, RAND, PHQ-2, and PHQ-9. The study team developed a list of domains and the tools available within each domain for stakeholders to prioritize at each site. The proposed workflows take into consideration the use of these data within the clinical encounter. Pilots at each site to collect PROs are underway along with the methodological work for data extraction and harmonization and will be reported at the meeting. Conclusions: The collection of a common set of PROs across EHRs has important implications for improving individual patient’s symptoms and for enhancing the quality of cancer care. Complex workflows and technical barriers must be considered successful implementation.
Understanding the financial impact of beyond use date in a publicly funded cancer system.
Authors: Redwood Erin , Vu Kathy , Fung Ron , Han Heekyung , Teimoortagh Megan , Meertens Elaine , Forbes Leta , Kukreti Vishal , Santaera Daniella 
Published: April 2017

13 Background: According to USP 797 and the National Association of Pharmacy Regulatory Authorities standards, the Beyond Use Date (BUD) based on sterility for single-dose vials is 6 hours, after which the contents must be discarded. In Ontario, centres have traditionally based BUD on stability data, not sterility data. This change presents concern about potential drug waste so an analysis was done to estimate the financial impact to the 76 systemic treatment facilities in Ontario. Methods: Using an administrative database that records the daily total dose of drugs administered by facility, annual drug waste cost was calculated using daily dose administered, cost per milligram, and available vial size(s) for 26 publicly funded drugs. Two different methods were used to determine the amount of drug waste. Method 1 used the largest vial size matched to the closest amount of drug required. Method 2 used the optimal vial size mix, when there are multiple vial sizes, to minimize wastage across all configurations of vial size. Some assumptions made include: 1) each facility had access to all available vial sizes, and 2) single-dose vial contents were true to the stated quantity as per the manufacturer. Results: The 10 facilities with the highest waste estimates are summarized in the table. The total waste estimates for all facilities are $25,927,861 (method 1) and $12,945,353 (method 2). Waste estimates were also calculated by drug, with rituximab, bevacizumab and pemetrexed having the highest waste costs. These drugs are only available in vials with a large range in size (100 and 500 mg), but could waste more than drugs with more size options or less variance between sizes. Conclusions: Assigning a BUD based on 6 hour sterility standards will have significant financial implications to facilities in Ontario. Development of mitigation strategies should be explored to provide guidance to Ontario and other jurisdictions on how to curtail the budget impact.[Table: see text]
Quality of information addressing treatment options for women with breast cancer on NCI cancer center websites.
Authors: Dulaney Caleb , Wakefield Daniel Victor , Rocque Gabrielle Betty , De Los Santos Jennifer F. 
Published: April 2017

135 Background: The internet is increasingly utilized by cancer patients for information that may influence treatment decisions. National Cancer Institute (NCI)-designated cancer center websites and nationally recognized cancer research agencies are trusted sources of information, however little data exists regarding the quality of information on these sites. We evaluated the quality and accessibility of breast cancer treatment information on cancer center websites addressing therapeutic options. Methods: Websites of all NCI cancer centers, the NCI, and Susan G. Komen were reviewed. Quality was measured using 33 questions from three validated Breast Cancer Decision Quality Instruments (DQI). Two blinded reviewers determined if websites provided information to answer each question. Number of clicks to reach the breast-specific webpage, evaluation time, and Spanish and mobile accessibility were recorded. Kappa coefficient was used to measure inter-observer variability. Correlation between evaluation time and questions answered was measured using Pearson coefficient. Results: Of the 63 cancer center websites evaluated, 94% had breast cancer webpages reached in a median of 2 clicks. Average evaluation time was 11 minutes. 24% were Spanish accessible. 59% were mobile friendly. No site provided information that addressed all questions. The most informative cancer center site addressed 76% of questions. On average, 21% of questions were addressed per site. 16% of sites did not have sufficient information to answer any question. In comparison, the NCI and Komen sites covered higher proportions of questions than cancer center sites (85 and 88%). Inter-observer variability was fair to moderate (avg. Kappa 0.37). Evaluation time strongly correlated with number of questions answered (r = 0.75). Conclusions: NCI cancer center websites provided informative feedback for breast cancer patients across an average 21% of key knowledge points in a validated DQI. This information is less accessible to Spanish speaking patients and patients using mobile devices. Website improvements represent an opportunity to enhance knowledge that may improve shared decision making for women with breast cancer.
Routine physical function assessment through a Branching Logic Electronic Symptom Survey (BLESS) vs. the 32-combined item HAQ-DI + WHODAS (HW) survey: A quality improvement controlled trial.
Authors: Tam Emily , Chen Judy , Zhang Qihuang , Zheng Dennis , Tam Vivian , Li Yuchen , Tse Tiffany , Brown M Catherine , Xu Wei , Howell Doris , Liu Geoffrey , Hall Elizabeth 
Published: April 2017

136 Background: Routine outpatient physical function assessment can improve quality of care by prioritizing supports for specific patients. However, conventional research surveys including the 32-combined item HAQ-DI + WHODAS (HW) may be burdensome to patients. To streamline this process, we have developed BLESS, an electronic patient reported outcomes software program that utilizes PRO-ECOG and EQ-5D-3L items to screen for physical dysfunction symptoms, with follow-up questions from HW; BLESS has been demonstrated to have high sensitivity and specificity for the complete HW survey. We compared completion times and patient acceptability of BLESS vs. HW. Methods: Adult oncology outpatients of all stages at Princess Margaret Cancer Centre were allocated prospectively and alternately to receive either BLESS or HW on touchscreen tablets. Completion times were recorded and a patient acceptability survey was administered. Results: Of 225 patients analyzed from breast (19%), GI (22%), GU (12%), gynecology (16%), head/neck (12%), skin (6%) and thoracic (13%) cancer clinics, 118 (52%) patients completed BLESS and 107 (47%) completed HW. Median age was 61 (range: 18-97) years; 60% were female, 68% were Caucasian, 44% were stage IV, and 57% were treated with a curative intent. There were no statistically significant differences in demographic and clinical characteristics between the arms analyzed. Median EQ-5D-3L utility was 0.83 (0.28-1.00), median HAQ-DI was 0.13 (0-3.00) and median WHODAS was 8.3% (0-83.3%). Compared to HW, BLESS resulted in a median completion time reduction of 3.9 minutes (32% decrease; p < 0.001). Although most patients in both arms did not find the survey time-consuming nor caused the clinic visit to be more difficult, a greater proportion of BLESS patients held a stronger conviction in their answers (p = 0.02 for both comparisons). Conclusions: In comparison to traditional research tools of HW for assessing physical function,BLESS was associated with shorter administration times and improved patient acceptability, rendering BLESS more suitable for routine clinical use.